Provider Demographics
NPI:1558857250
Name:FOOT & ANKLE CONSULTANTS OF TEXAS, LLC
Entity Type:Organization
Organization Name:FOOT & ANKLE CONSULTANTS OF TEXAS, LLC
Other - Org Name:FOOT & ANKLE CONSULTANTS OF TEXAS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PODIATRIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-881-0110
Mailing Address - Street 1:412 VILLAGE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4634
Mailing Address - Country:US
Mailing Address - Phone:972-427-3228
Mailing Address - Fax:
Practice Address - Street 1:412 VILLAGE DR STE 300
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4634
Practice Address - Country:US
Practice Address - Phone:972-881-0110
Practice Address - Fax:972-633-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2344213ES0103X, 261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2344OtherTEXAS PODIATRY LICENSE FROM TDLR