Provider Demographics
NPI:1922367663
Name:ATWAY, EIDEH D (DPM)
Entity Type:Individual
Prefix:DR
First Name:EIDEH
Middle Name:D
Last Name:ATWAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1117
Mailing Address - Country:US
Mailing Address - Phone:805-836-2867
Mailing Address - Fax:214-540-8547
Practice Address - Street 1:1245 FALCON DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-1117
Practice Address - Country:US
Practice Address - Phone:805-836-2867
Practice Address - Fax:214-540-8547
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist