Organization
PRIVIA MEDICAL GROUP GULF COAST, PLLC
Active
Other names
Shine Foot and Ankle Center, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA JORDAN (AUTHORIZED OFFICIAL)
(713) 512-7613
Entity
Organization
Contact information
Practice address
3901 MEDICAL PKWY STE 301, AUSTIN, TX 78756-4022
(512) 399-5711
Mailing address
1200 BINZ ST STE 1490, HOUSTON, TX 77004-6946
(713) 512-7700
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Enumeration date
06/23/2022
Last updated
07/07/2022
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