Provider Demographics
NPI:1932309812
Name:QUEZADA, JOSEPH MARTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARTIN
Last Name:QUEZADA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6999 MCPHERSON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6449
Mailing Address - Country:US
Mailing Address - Phone:956-722-7778
Mailing Address - Fax:956-794-8763
Practice Address - Street 1:6999 MCPHERSON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6449
Practice Address - Country:US
Practice Address - Phone:956-722-7778
Practice Address - Fax:956-794-8763
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024213EP1101X, 213ES0131X, 213ES0103X, 213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0716871OtherCINGA
TXP01155072OtherRAILROAD PROVIDER PTAN
TX268159YNKLMedicare PIN
TXP01155072OtherRAILROAD PROVIDER PTAN
NYP06121Medicare UPIN