Provider Demographics
NPI:1942293139
Name:PHELPS, DANIEL HUBBARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HUBBARD
Last Name:PHELPS
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 1:321 S FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7321
Mailing Address - Country:US
Mailing Address - Phone:903-593-0987
Mailing Address - Fax:903-592-3309
Practice Address - Street 1:321 S FANNIN AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7321
Practice Address - Country:US
Practice Address - Phone:903-593-0987
Practice Address - Fax:903-592-3309
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0538213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119886304Medicaid
TX480026505OtherMEDICARE RAILROAD
TX480026505OtherMEDICARE RAILROAD
TX4356860001Medicare NSC