Provider Demographics
NPI:1548654569
Name:LEGACY FOOT AND ANKLE SPECIALISTS
Entity type:Organization
Organization Name:LEGACY FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:GREGG
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-826-2397
Mailing Address - Street 1:5575 WARREN PKWY
Mailing Address - Street 2:#104
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4062
Mailing Address - Country:US
Mailing Address - Phone:214-705-2585
Mailing Address - Fax:
Practice Address - Street 1:5575 WARREN PKWY
Practice Address - Street 2:#104
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4062
Practice Address - Country:US
Practice Address - Phone:214-705-2585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty