Provider Demographics
NPI:1336318229
Name:SOUTHWEST PODIATRY, LLP
Entity Type:Organization
Organization Name:SOUTHWEST PODIATRY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER, SOUTHWEST PODIATR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-566-3808
Mailing Address - Street 1:18208 PRESTON RD
Mailing Address - Street 2:SUITE D-9 LB 112
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6007
Mailing Address - Country:US
Mailing Address - Phone:972-566-3808
Mailing Address - Fax:972-566-4690
Practice Address - Street 1:4333 N JOSEY LN
Practice Address - Street 2:PLAZA II SUITE 102
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4629
Practice Address - Country:US
Practice Address - Phone:972-394-0825
Practice Address - Fax:972-394-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4600300001Medicare NSC