Provider Demographics
NPI:1215039573
Name:NUSSBAUM, MEYNARD MORRIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MEYNARD
Middle Name:MORRIE
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:9740 BARKER CYPRESS RD
Mailing Address - Street 2:STE 108B
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1974
Mailing Address - Country:US
Mailing Address - Phone:832-781-2690
Mailing Address - Fax:832-409-3169
Practice Address - Street 1:9740 BARKER CYPRESS RD
Practice Address - Street 2:STE 108B
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1974
Practice Address - Country:US
Practice Address - Phone:832-781-2690
Practice Address - Fax:832-409-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0456213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0456OtherSTATE LICENSE NUMBER
TX018796501Medicaid
TXT15079Medicare UPIN
TX018796501Medicaid