Provider Demographics
NPI:1760497408
Name:CORPUS CHRISTI PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:CORPUS CHRISTI PODIATRY ASSOCIATES
Other - Org Name:CORPUS CHRISTI PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GOUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:361-883-5955
Mailing Address - Street 1:2601 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1815
Mailing Address - Country:US
Mailing Address - Phone:361-883-5955
Mailing Address - Fax:361-882-3365
Practice Address - Street 1:2601 HOSPITAL BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1815
Practice Address - Country:US
Practice Address - Phone:361-883-5955
Practice Address - Fax:361-882-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A9760OtherBC/BS
TX1499300OtherAETNA
TX1499300OtherAETNA
TX4101290001Medicare NSC