Provider Demographics
NPI:1093799249
Name:RESIGNATO, PAUL JEFFREY (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JEFFREY
Last Name:RESIGNATO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3192
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79923-3192
Mailing Address - Country:US
Mailing Address - Phone:915-855-3338
Mailing Address - Fax:915-564-5579
Practice Address - Street 1:1722 N ZARAGOZA RD
Practice Address - Street 2:STE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-8033
Practice Address - Country:US
Practice Address - Phone:915-855-3338
Practice Address - Fax:915-564-5579
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0871213ES0103X
TX871213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110391302Medicaid
TX110391302Medicaid
T15506Medicare UPIN
TX6421010001Medicare NSC
00BY78Medicare PIN