Provider Demographics
NPI:1124081575
Name:LAMOUR, JEFFERY WILLIAM (DPM)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:WILLIAM
Last Name:LAMOUR
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 1:8015 SHOAL CREEK BLVD
Mailing Address - Street 2:#119
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8066
Mailing Address - Country:US
Mailing Address - Phone:512-451-3668
Mailing Address - Fax:512-451-1823
Practice Address - Street 1:8015 SHOAL CREEK BLVD
Practice Address - Street 2:#119
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8066
Practice Address - Country:US
Practice Address - Phone:512-451-3668
Practice Address - Fax:512-451-1823
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1322213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K3480OtherBCBS
TX092771702Medicaid
TX092771702Medicaid
TX8K3480OtherBCBS