Provider Demographics
NPI:1366460164
Name:PRIGOFF-BOWERS LLP
Entity Type:Organization
Organization Name:PRIGOFF-BOWERS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:214-337-8949
Mailing Address - Street 1:2909 S HAMPTON RD
Mailing Address - Street 2:STE B102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224
Mailing Address - Country:US
Mailing Address - Phone:214-337-8949
Mailing Address - Fax:214-339-0090
Practice Address - Street 1:2909 S HAMPTON RD
Practice Address - Street 2:STE B102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-337-8949
Practice Address - Fax:214-339-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0349213ES0103X
TX1377213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169406901Medicaid
TX169406903OtherMEDICAID DME
169406902OtherMEDICAID DME
TX169406903OtherMEDICAID DME
169406902OtherMEDICAID DME
TX5160020001Medicare NSC
00404VMedicare ID - Type Unspecified