MEDICARE: DORA EDA ACHILLE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	1456	TX

General Provider Information

NPI Number	:	1013952514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORA EDA ACHILLE DPM

Provider Business Mailing Address
First Line	:	3208 LONG PRAIRIE RD
Second Line	:	SUITE B
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2718
Country	:	US
Telephone Number	:	972-539-8488
Fax Number	:	972-874-1107

Provider Business Practice Location Address
First Line	:	3208 LONG PRAIRIE RD
Second Line	:	SUITE B
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2718
Country	:	US
Telephone Number	:	972-539-8488
Fax Number	:	972-874-1107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/08/2007

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