Organization
PRYME FOOT & ANKLE CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY HAMILTON DMD (OWNER)
(682) 223-2400
Entity
Organization
Contact information
Practice address
1759 BROAD PARK CIR S #205, MANSFIELD, TX 76063-7834
(682) 223-2400
(682) 334-7061
Mailing address
1759 BROAD PARK CIR S #205, MANSFIELD, TX 76063-7834
(682) 223-2400
(682) 334-7061
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
213ES0131X
Foot Surgery Podiatrist
—
—
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
811363748
TAX ID
—
Enumeration date
07/20/2017
Last updated
01/31/2018
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