Provider Demographics
NPI:1124205158
Name:WEATHERFORD PODIATRY CLINICS, P.A.
Entity Type:Organization
Organization Name:WEATHERFORD PODIATRY CLINICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYMON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-341-3901
Mailing Address - Street 1:PO BOX 1926
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7926
Mailing Address - Country:US
Mailing Address - Phone:817-341-3901
Mailing Address - Fax:817-599-7018
Practice Address - Street 1:925 SANTA FE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5866
Practice Address - Country:US
Practice Address - Phone:817-341-3901
Practice Address - Fax:817-599-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1477213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124205158OtherBCBS
TX018603301Medicaid
TX8F9596Medicare PIN