Provider Demographics
NPI:1417993445
Name:VAROZ, THEODORE LAWRENCE (DPM)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:LAWRENCE
Last Name:VAROZ
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 1:1204 C CANDELARIA NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2766
Mailing Address - Country:US
Mailing Address - Phone:505-345-8529
Mailing Address - Fax:505-345-6410
Practice Address - Street 1:1204 C CANDELARIA NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2766
Practice Address - Country:US
Practice Address - Phone:505-345-8529
Practice Address - Fax:505-345-6410
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM219213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53363Medicaid
NMCS00010705OtherCONTROLLED SUBSTANCE REGI
BV2179857OtherFEDERAL DEA
2350509Medicare ID - Type UnspecifiedFEDERAL
NM53363Medicaid