Provider Demographics
NPI:1548222318
Name:HOSACK, DAVID A (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:HOSACK
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:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-0783
Mailing Address - Country:US
Mailing Address - Phone:979-297-3204
Mailing Address - Fax:979-297-6220
Practice Address - Street 1:107 CIRCLE WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5233
Practice Address - Country:US
Practice Address - Phone:979-297-3204
Practice Address - Fax:979-297-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP 1063213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018624901Medicaid
TX018624901Medicaid
TX0485390001Medicare NSC
TXUO7501Medicare UPIN