Provider Demographics
NPI:1467630541
Name:FOOTCARE, P.A.
Entity Type:Organization
Organization Name:FOOTCARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MASHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-939-1757
Mailing Address - Street 1:4333 N JOSEY LN STE 206
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4631
Mailing Address - Country:US
Mailing Address - Phone:972-939-1757
Mailing Address - Fax:972-939-1682
Practice Address - Street 1:5940 W PARKER RD STE 202
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6404
Practice Address - Country:US
Practice Address - Phone:972-781-1970
Practice Address - Fax:972-781-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0014CZOtherBCBS GROUP ID
TX080689501Medicaid
TX00497KMedicare PIN
TX080689501Medicaid