Provider Demographics
NPI:1851399893
Name:BRAZOS FOOT AND ANKLE CLINIC P.A.
Entity Type:Organization
Organization Name:BRAZOS FOOT AND ANKLE CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.P.M.
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-578-8555
Mailing Address - Street 1:1201 MEDICAL PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5684
Mailing Address - Country:US
Mailing Address - Phone:817-578-8555
Mailing Address - Fax:817-573-6234
Practice Address - Street 1:1201 MEDICAL PLAZA CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5684
Practice Address - Country:US
Practice Address - Phone:817-578-8555
Practice Address - Fax:817-573-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU92779Medicare UPIN
TX00821VMedicare PIN
TXDB0173Medicare PIN
TX5117540001Medicare NSC