Provider Demographics
NPI:1497150312
Name:DR. MOFFAT D. ADAMS JR., DPM PLLC
Entity Type:Organization
Organization Name:DR. MOFFAT D. ADAMS JR., DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOFFATT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-497-4642
Mailing Address - Street 1:16607 BLANCO RD, SUITE 12205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-497-4642
Mailing Address - Fax:210-314-1375
Practice Address - Street 1:16607 BLANCO RD, SUITE 12205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-497-4642
Practice Address - Fax:210-314-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1845213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty