Provider Demographics
NPI:1760659213
Name:FOOT AND ANKLE CENTERS OF TEXAS PA
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTERS OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-554-0111
Mailing Address - Street 1:PO BOX 57310
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7310
Mailing Address - Country:US
Mailing Address - Phone:281-554-0111
Mailing Address - Fax:281-332-1787
Practice Address - Street 1:505 W FAIRMONT PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6312
Practice Address - Country:US
Practice Address - Phone:281-554-0111
Practice Address - Fax:281-332-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193842501Medicaid
TX193842501Medicaid
TX6101820001Medicare NSC