Provider Demographics
NPI:1568532950
Name:CZELUSTA, LAWRENCE ALLEN I (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:CZELUSTA
Suffix:I
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 1:9325 SCHOENTHAL RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2858
Mailing Address - Country:US
Mailing Address - Phone:210-656-6383
Mailing Address - Fax:210-651-9097
Practice Address - Street 1:8601 VILLAGE DR STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5509
Practice Address - Country:US
Practice Address - Phone:210-656-6383
Practice Address - Fax:210-967-5766
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633213EP1101X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333800YX2YOtherPTAN
TX00FF35OtherBCBS PROVIDER NUMBER
TX00FF35OtherBCBS PROVIDER NUMBER