Provider Demographics
NPI:1356809248
Name:LEGACY FOOT & ANKLE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:LEGACY FOOT & ANKLE SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MINH-NGOC
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-602-6882
Mailing Address - Street 1:3031 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1853
Mailing Address - Country:US
Mailing Address - Phone:832-620-6882
Mailing Address - Fax:
Practice Address - Street 1:1485 FM 1960 BYPASS RD E STE 200
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3965
Practice Address - Country:US
Practice Address - Phone:281-324-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-09
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty