Provider Demographics
NPI:1770588634
Name:BASTAWROS, DAVID S (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:BASTAWROS
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:PO BOX 261126
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-1126
Mailing Address - Country:US
Mailing Address - Phone:972-491-3000
Mailing Address - Fax:972-491-3001
Practice Address - Street 1:4716 ALLIANCE BLVD
Practice Address - Street 2:STE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5371
Practice Address - Country:US
Practice Address - Phone:469-814-3480
Practice Address - Fax:469-814-3490
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1459213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00665455OtherMEDICARE RAILROAD
TX8096K0Medicare UPIN
TXP00665455OtherMEDICARE RAILROAD
TX8096K0Medicare PIN