Provider Demographics
NPI:1891954657
Name:THEODORE L VAROZ DPM
Entity Type:Organization
Organization Name:THEODORE L VAROZ DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-345-8529
Mailing Address - Street 1:1204 CANDELARIA RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2766
Mailing Address - Country:US
Mailing Address - Phone:505-345-8529
Mailing Address - Fax:505-345-6410
Practice Address - Street 1:1204 CANDELARIA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2766
Practice Address - Country:US
Practice Address - Phone:505-345-8529
Practice Address - Fax:505-345-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM219213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1020880001Medicare NSC