Provider Demographics
NPI:1235240086
Name:BEAUMONT FOOT SPECIALISTS INC
Entity Type:Organization
Organization Name:BEAUMONT FOOT SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BRUYN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:409-833-7465
Mailing Address - Street 1:450 NORTH 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702
Mailing Address - Country:US
Mailing Address - Phone:409-833-7465
Mailing Address - Fax:409-833-7719
Practice Address - Street 1:450 NORTH 11TH STREET
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702
Practice Address - Country:US
Practice Address - Phone:409-833-7465
Practice Address - Fax:409-833-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020228502Medicaid
TX00359XMedicare ID - Type Unspecified
TX020228502Medicaid