Provider Demographics
NPI:1205866548
Name:TOUSSAINT, ROSELINE (DPM)
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:TOUSSAINT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 LIFFEY DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5109
Mailing Address - Country:US
Mailing Address - Phone:512-563-5736
Mailing Address - Fax:
Practice Address - Street 1:1024 LIFFEY DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5109
Practice Address - Country:US
Practice Address - Phone:512-563-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1773213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182320501Medicaid
TX612572OtherRAILROAD MEDICARE
TX182320502Medicaid
TX8AQ580OtherBLUE SHIELD
TX8AQ580OtherBLUE SHIELD
TX182320501Medicaid
TXV09948Medicare UPIN