Provider Demographics
NPI:1831872555
Name:FOOT AND ANKLE ASSOCIATES OF FORT WORTH, PLLC
Entity type:Organization
Organization Name:FOOT AND ANKLE ASSOCIATES OF FORT WORTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:NEALE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-821-5991
Mailing Address - Street 1:1001 12TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3928
Mailing Address - Country:US
Mailing Address - Phone:817-336-6600
Mailing Address - Fax:
Practice Address - Street 1:1001 12TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3928
Practice Address - Country:US
Practice Address - Phone:817-336-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty