Healthcare Provider Details

I. General information

NPI: 1124081575
Provider Name (Legal Business Name): JEFFERY WILLIAM LAMOUR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 SHOAL CREEK BLVD #119
AUSTIN TX
78757-8066
US

IV. Provider business mailing address

8015 SHOAL CREEK BLVD #119
AUSTIN TX
78757-8066
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-3668
  • Fax: 512-451-1823
Mailing address:
  • Phone: 512-451-3668
  • Fax: 512-451-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1322
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: