Provider Demographics
NPI:1649651837
Name:SOUTHWEST LASER CARE PLLC
Entity type:Organization
Organization Name:SOUTHWEST LASER CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:915-491-6346
Mailing Address - Street 1:1407 ELM ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-2909
Mailing Address - Country:US
Mailing Address - Phone:915-491-6346
Mailing Address - Fax:815-301-5599
Practice Address - Street 1:1533 N LEE TREVINO DR
Practice Address - Street 2:C1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5170
Practice Address - Country:US
Practice Address - Phone:915-491-6346
Practice Address - Fax:815-301-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1749213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty