Provider Demographics
NPI:1538562038
Name:EAST TEXAS FOOT AND ANKLE CARE PLLC
Entity type:Organization
Organization Name:EAST TEXAS FOOT AND ANKLE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-941-9247
Mailing Address - Street 1:9209 STONEBANK XING
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0829
Mailing Address - Country:US
Mailing Address - Phone:903-941-9247
Mailing Address - Fax:888-503-2519
Practice Address - Street 1:9209 STONEBANK XING
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0829
Practice Address - Country:US
Practice Address - Phone:903-941-9247
Practice Address - Fax:888-503-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty