Healthcare Provider Details

I. General information

NPI: 1255510103
Provider Name (Legal Business Name): DAVID S BASTAWROS DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 ALLIANCE BLVD STE 300
PLANO TX
75093-5314
US

IV. Provider business mailing address

PO BOX 261126
PLANO TX
75026-1126
US

V. Phone/Fax

Practice location:
  • Phone: 469-814-3816
  • Fax: 469-814-3490
Mailing address:
  • Phone: 972-491-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1459
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID S. BASTAWROS
Title or Position: PRESIDENT
Credential: DPM
Phone: 972-491-3000