Liberty Dayton Foot & Ankle Center

NPI #1689603805 in Liberty, Texas

Provider Information

NPI Number: 1689603805
Entity Type: Organization
Organization Name: Liberty Dayton Foot & Ankle Center
Primary Specialty: Podiatrist
Enumeration Date: Jul 1, 2006
Last Updated: Jun 19, 2009

Practice Location

Address: 1825 GRAND AVE
City: Liberty
State: Texas
ZIP Code: 77575-4705
Phone: (936) 336-2633

Authorized Official

Name: DR. LAWRENCE S MACTAVISH, D.P.M.
Title: PHYSICIAN OWNER
Phone: (936) 336-2633

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Podiatrist	213E00000X	Primary

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