MEDICARE: GARY JAY KAISERMAN D.P.M.

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	0723	TX

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

General Provider Information

NPI Number	:	1871707927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY JAY KAISERMAN D.P.M.

Provider Business Mailing Address
First Line	:	2431 W KIEST BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-2305
Country	:	US
Telephone Number	:	214-339-2133
Fax Number	:	214-467-3338

Provider Business Practice Location Address
First Line	:	2431 W KIEST BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-2305
Country	:	US
Telephone Number	:	214-339-2133
Fax Number	:	214-467-3338

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	04/28/2014

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