Provider Demographics
NPI:1447423280
Name:HILL COUNTRY FOOD DOCTOR
Entity Type:Organization
Organization Name:HILL COUNTRY FOOD DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-805-7787
Mailing Address - Street 1:1320 WONDER WORLD DR
Mailing Address - Street 2:STE 107
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7557
Mailing Address - Country:US
Mailing Address - Phone:512-805-7787
Mailing Address - Fax:205-333-5550
Practice Address - Street 1:1320 WONDER WORLD DR
Practice Address - Street 2:STE 107
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7557
Practice Address - Country:US
Practice Address - Phone:512-805-7787
Practice Address - Fax:205-333-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1349213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018587801Medicaid
1972597953OtherNPI INDIVIDUAL
TX5492990001Medicare NSC
U66863Medicare UPIN
TX018587801Medicaid