Provider Demographics
NPI:1083826747
Name:WEST TEXAS FOOT SPECIALIST PA
Entity Type:Organization
Organization Name:WEST TEXAS FOOT SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LANIER
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:806-795-8037
Mailing Address - Street 1:4412 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-3610
Mailing Address - Country:US
Mailing Address - Phone:806-795-8037
Mailing Address - Fax:806-799-6218
Practice Address - Street 1:4412 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3610
Practice Address - Country:US
Practice Address - Phone:806-795-8037
Practice Address - Fax:806-799-6218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0347213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCG1826OtherRR MED
TX5822330001Medicare NSC
TX00R82HMedicare PIN