Provider Demographics
NPI:1376721506
Name:ANTHONY P NOREIGA DPM PA
Entity Type:Organization
Organization Name:ANTHONY P NOREIGA DPM PA
Other - Org Name:LUFKIN MEDICAL FOOT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OF PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:NOREIGA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:936-637-3383
Mailing Address - Street 1:900 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3335
Mailing Address - Country:US
Mailing Address - Phone:936-637-3383
Mailing Address - Fax:
Practice Address - Street 1:900 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3335
Practice Address - Country:US
Practice Address - Phone:936-637-3383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127185004Medicaid
TX00020EMedicare PIN
TX127185004Medicaid
TX4671540001Medicare NSC
TX480030862Medicare PIN