Healthcare Provider Details

I. General information

NPI: 1720268741
Provider Name (Legal Business Name): MOFFATT DAVID ADAMS JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16607 BLANCO RD STE 12205
SAN ANTONIO TX
78232-1963
US

IV. Provider business mailing address

19141 STONE OAK PKWY STE 104
SAN ANTONIO TX
78258-3367
US

V. Phone/Fax

Practice location:
  • Phone: 210-497-4642
  • Fax: 210-314-1375
Mailing address:
  • Phone: 210-497-4642
  • Fax: 210-495-7245

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:
Title or Position:
Credential:
Phone: