Provider Demographics
NPI:1922761998
Name:ISLAND FOOT AND ANKLE, PLLC
Entity Type:Organization
Organization Name:ISLAND FOOT AND ANKLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MASCORRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:409-405-1977
Mailing Address - Street 1:PO BOX 1553
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553-1553
Mailing Address - Country:US
Mailing Address - Phone:409-405-1977
Mailing Address - Fax:409-405-1728
Practice Address - Street 1:4920 SEAWALL BLVD STE B
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-6011
Practice Address - Country:US
Practice Address - Phone:409-405-1977
Practice Address - Fax:409-405-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty