Healthcare Provider Details

I. General information

NPI: 1497899827
Provider Name (Legal Business Name): DALLAS PODIATRY WORKS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN A212
DALLAS TX
75230-2535
US

IV. Provider business mailing address

7777 FOREST LN STE A212
DALLAS TX
75230-2505
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-7474
  • Fax: 972-566-7479
Mailing address:
  • Phone: 972-566-7474
  • Fax: 972-566-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1345
License Number StateTX

VIII. Authorized Official

Name: JOEL W BROOK
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 972-566-7474