Provider Demographics
NPI:1649911637
Name:TOE-TAL FOOT CARE, PLLC
Entity type:Organization
Organization Name:TOE-TAL FOOT CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GAULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:501-500-0155
Mailing Address - Street 1:101A DORIS CT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4044
Mailing Address - Country:US
Mailing Address - Phone:501-500-0155
Mailing Address - Fax:501-246-8647
Practice Address - Street 1:101A DORIS CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4044
Practice Address - Country:US
Practice Address - Phone:501-500-0155
Practice Address - Fax:501-246-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR225822717Medicaid
AR285389748Medicaid