Healthcare Provider Details

I. General information

NPI: 1295767788
Provider Name (Legal Business Name): GERALD BRIAN MCCOOL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EL PASO VETERANS ADMINISTRATION 5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

IV. Provider business mailing address

EL PASO VETERANS ADMINISTRATION 5001 N PIEDRAS ST
EL PASO TX
79930-4210
US

V. Phone/Fax

Practice location:
  • Phone: 915-355-1102
  • Fax:
Mailing address:
  • Phone: 915-355-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number916
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: