Provider Demographics
NPI:1245210830
Name:LEPOW, RANDAL M (DPM)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:M
Last Name:LEPOW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST STE 1712
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2725
Mailing Address - Country:US
Mailing Address - Phone:713-790-0530
Mailing Address - Fax:713-790-9320
Practice Address - Street 1:6560 FANNIN ST STE 1712
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2725
Practice Address - Country:US
Practice Address - Phone:713-790-0530
Practice Address - Fax:713-790-9320
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX811213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121589906Medicaid
8J0021Medicare PIN
T14386Medicare UPIN
TX121589902Medicaid