Provider Demographics
NPI:1730141623
Name:JEFFERY W. LAMOUR, DPM, PA
Entity Type:Organization
Organization Name:JEFFERY W. LAMOUR, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LAMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-451-3668
Mailing Address - Street 1:8015 SHOAL CREEK BLVD
Mailing Address - Street 2:#119
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8066
Mailing Address - Country:US
Mailing Address - Phone:512-451-3668
Mailing Address - Fax:512-451-1823
Practice Address - Street 1:8015 SHOAL CREEK BLVD
Practice Address - Street 2:#119
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8066
Practice Address - Country:US
Practice Address - Phone:512-451-3668
Practice Address - Fax:512-451-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1322213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0086KPOtherBCBS
TX092771702Medicaid
TX0086KPOtherBCBS