Provider Demographics
NPI:1497899827
Name:DALLAS PODIATRY WORKS PA
Entity Type:Organization
Organization Name:DALLAS PODIATRY WORKS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-566-7474
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:STE A212
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-7474
Mailing Address - Fax:972-566-7479
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:A212
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2535
Practice Address - Country:US
Practice Address - Phone:972-566-7474
Practice Address - Fax:972-566-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1345213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5858160001Medicare NSC