Provider Demographics
NPI:1114179884
Name:EDDIE DAVIS, DPM, PLLC
Entity Type:Organization
Organization Name:EDDIE DAVIS, DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-490-3668
Mailing Address - Street 1:109 GALLERY CIR STE 119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3328
Mailing Address - Country:US
Mailing Address - Phone:210-490-3668
Mailing Address - Fax:210-267-5262
Practice Address - Street 1:109 GALLERY CIR STE 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3328
Practice Address - Country:US
Practice Address - Phone:210-490-3668
Practice Address - Fax:210-267-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1818213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2094732 GROUPMedicaid
TX6184500002Medicare NSC
TX0A0258 GROUPMedicare PIN
TXT32367Medicare UPIN