Provider Demographics
NPI:1811369341
Name:FULSHEAR FOOT AND ANKLE PLLC
Entity Type:Organization
Organization Name:FULSHEAR FOOT AND ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MASCORRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-391-1212
Mailing Address - Street 1:7609 TIKI DR STE D
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1678
Mailing Address - Country:US
Mailing Address - Phone:281-391-1212
Mailing Address - Fax:
Practice Address - Street 1:7609 TIKI DR STE D
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1678
Practice Address - Country:US
Practice Address - Phone:281-391-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty