Healthcare Provider Details

I. General information

NPI: 1497150312
Provider Name (Legal Business Name): DR. MOFFAT D. ADAMS JR., DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 01/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16607 BLANCO RD, SUITE 12205
SAN ANTONIO TX
78232
US

IV. Provider business mailing address

16607 BLANCO RD, SUITE 12205
SAN ANTONIO TX
78232
US

V. Phone/Fax

Practice location:
  • Phone: 210-497-4642
  • Fax: 210-314-1375
Mailing address:
  • Phone: 210-497-4642
  • Fax: 210-314-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1845
License Number StateTX

VIII. Authorized Official

Name: DR. MOFFATT DAVID ADAMS JR.
Title or Position: PRESIDENT
Credential: DPM
Phone: 210-497-4642