Provider Demographics
NPI:1225761166
Name:PREMIER PODIATRY
Entity Type:Organization
Organization Name:PREMIER PODIATRY
Other - Org Name:PREMIER PODIATRY, PLLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:D'ALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-649-7442
Mailing Address - Street 1:4422 PACK SADDLE PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1681
Mailing Address - Country:US
Mailing Address - Phone:814-636-7736
Mailing Address - Fax:
Practice Address - Street 1:4422 PACK SADDLE PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1681
Practice Address - Country:US
Practice Address - Phone:814-636-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty