Provider Demographics
NPI:1912196833
Name:FOOT SPECIALTY ASSOCIATES
Entity Type:Organization
Organization Name:FOOT SPECIALTY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-845-0200
Mailing Address - Street 1:5427 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3555
Mailing Address - Country:US
Mailing Address - Phone:314-845-0200
Mailing Address - Fax:314-845-3223
Practice Address - Street 1:5427 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3555
Practice Address - Country:US
Practice Address - Phone:314-845-0200
Practice Address - Fax:314-845-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000714213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty