Provider Demographics
NPI:1598437022
Name:MEDICAL CENTER PODIATRY, PLLC
Entity Type:Organization
Organization Name:MEDICAL CENTER PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAUTHON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-848-4783
Mailing Address - Street 1:9150 HUEBNER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1545
Mailing Address - Country:US
Mailing Address - Phone:210-561-7080
Mailing Address - Fax:210-561-7040
Practice Address - Street 1:9150 HUEBNER RD STE 160
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-561-7080
Practice Address - Fax:210-561-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-03
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558622910OtherNPI