Provider Demographics
NPI:1205194263
Name:DAVID A. ANDREONE DPM PLLC
Entity Type:Organization
Organization Name:DAVID A. ANDREONE DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDREONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-595-2858
Mailing Address - Street 1:921 SHILOH ROAD
Mailing Address - Street 2:STE C110
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1406
Mailing Address - Country:US
Mailing Address - Phone:903-595-2858
Mailing Address - Fax:903-595-6970
Practice Address - Street 1:921 SHILOH ROAD
Practice Address - Street 2:STE C110
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1406
Practice Address - Country:US
Practice Address - Phone:903-595-2858
Practice Address - Fax:903-595-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1481213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty