MEDICARE: WILLIAM FREDERICK BLANK III 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	213E00000X	Podiatrist	1416	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00381651	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235121864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM FREDERICK BLANK III DPM

Provider Business Mailing Address
First Line	:	21175 STATE HIGHWAY 249 # 192
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1655
Country	:	US
Telephone Number	:	713-254-2883
Fax Number	:	713-426-2034

Provider Business Practice Location Address
First Line	:	18960 N MEMORIAL DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4216
Country	:	US
Telephone Number	:	281-540-6322
Fax Number	:	713-426-2034

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	05/24/2012

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Directions to “ WILLIAM FREDERICK BLANK III DPM” Practice Location

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