Healthcare Provider Details

I. General information

NPI: 1700812161
Provider Name (Legal Business Name): SOUTHWEST PODIATRY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18208 PRESTON RD SUITE D-9 LB 112
DALLAS TX
75252-6007
US

IV. Provider business mailing address

18208 PRESTON RD SUITE D-9 LB 112
DALLAS TX
75252-6007
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-3808
  • Fax: 972-566-4690
Mailing address:
  • Phone: 972-566-3808
  • Fax: 972-566-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD R. BLUM
Title or Position: MANAGING PARTNER, SOUTHWEST PODIATR
Credential: DPM
Phone: 972-566-3808