Provider Demographics
NPI:1942315049
Name:SCHWARZENTRAUB, PAUL HOWARD (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HOWARD
Last Name:SCHWARZENTRAUB
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 1:4601 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-4828
Mailing Address - Country:US
Mailing Address - Phone:806-793-3668
Mailing Address - Fax:806-792-6664
Practice Address - Street 1:4601 66TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4828
Practice Address - Country:US
Practice Address - Phone:806-793-3668
Practice Address - Fax:806-792-6664
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0661213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15798Medicare UPIN
TX87100NMedicare ID - Type Unspecified