Provider Demographics
NPI:1649260092
Name:CODWELL, JOHN E III (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:CODWELL
Suffix:III
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 1:6655 TRAVIS ST STE 840
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1342
Mailing Address - Country:US
Mailing Address - Phone:713-526-0600
Mailing Address - Fax:713-526-7121
Practice Address - Street 1:6655 TRAVIS ST STE 840
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1342
Practice Address - Country:US
Practice Address - Phone:713-526-0600
Practice Address - Fax:713-526-7121
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1279213E00000X
TXTX 1279213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00928350-02Medicaid
TX4876770001Medicare NSC
TXU-55376Medicare UPIN
TX00R83MMedicare ID - Type Unspecified