Healthcare Provider Details

I. General information

NPI: 1730141623
Provider Name (Legal Business Name): JEFFERY W. LAMOUR, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 09/27/2011
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: JEFFREY WILLIAM LAMOUR
Title or Position: OWNER
Credential: DPM
Phone: 512-451-3668