Provider Demographics
NPI:1740272491
Name:PEHDE, COLLIN EUGENE (DPM)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:EUGENE
Last Name:PEHDE
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 1:701 S ZARZAMORA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5209
Mailing Address - Country:US
Mailing Address - Phone:210-358-7717
Mailing Address - Fax:210-358-7707
Practice Address - Street 1:701 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5209
Practice Address - Country:US
Practice Address - Phone:210-358-7717
Practice Address - Fax:210-358-7707
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2166213E00000X, 213ES0103X
IA00782213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01045640OtherRR MEDICARE
IA1912278490Medicaid
TX352540401Medicaid
TX8FL880OtherBLUE CROSS BLUE SHIELD OF TEXAS
IA1912278490OtherWELLMARK BCBS
TX447448ZRNCOtherMEDICARE PTAN
V04934Medicare UPIN
TX352540401Medicaid
IAIB2441001Medicare PIN