MEDICARE: MEYNARD M. NUSSBAUM DPM PA

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	0456	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
2	0456	OTHER	TX	TX MEDICAL LICENSE

General Provider Information

NPI Number	:	1992988661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEYNARD M. NUSSBAUM DPM PA

Provider Business Mailing Address
First Line	:	2500 FONDREN ROAD
Second Line	:	SUITE 255
City	:	HOUSTON
State	:	TX
Zip	:	77063-2313
Country	:	US
Telephone Number	:	713-781-0019
Fax Number	:	713-781-1112

Provider Business Practice Location Address
First Line	:	2500 FONDREN ROAD
Second Line	:	SUITE 255
City	:	HOUSTON
State	:	TX
Zip	:	77063-2313
Country	:	US
Telephone Number	:	713-781-0019
Fax Number	:	713-781-1112

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEYNARD MORRIE NUSSBAUM
Credential	:	DPM PA
Telephone Number	:	713-781-0019

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	10/14/2016

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