Provider Demographics
NPI:1568688737
Name:P J NAIRNE DPM PLLC
Entity Type:Organization
Organization Name:P J NAIRNE DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NAIRNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-816-6030
Mailing Address - Street 1:407 N CEDAR RIDGE DR
Mailing Address - Street 2:225
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3169
Mailing Address - Country:US
Mailing Address - Phone:972-816-6030
Mailing Address - Fax:972-299-9998
Practice Address - Street 1:407 N CEDAR RIDGE DR
Practice Address - Street 2:225
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3169
Practice Address - Country:US
Practice Address - Phone:972-816-6030
Practice Address - Fax:972-299-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1468213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177282401Medicaid
TX196280501Medicaid
TX018595101Medicaid
TXT 87509Medicare UPIN
TX00Z732Medicare PIN
TX5312260001Medicare NSC