Provider Demographics
NPI:1801308234
Name:PETE O'DONALD DPM, PLLC
Entity type:Organization
Organization Name:PETE O'DONALD DPM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:O'DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:409-727-1122
Mailing Address - Street 1:2234 NEDERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-3926
Mailing Address - Country:US
Mailing Address - Phone:409-727-1773
Mailing Address - Fax:409-727-1433
Practice Address - Street 1:2234 NEDERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-3926
Practice Address - Country:US
Practice Address - Phone:409-727-1773
Practice Address - Fax:409-727-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370258101Medicaid