Healthcare Provider Details

I. General information

NPI: 1679640122
Provider Name (Legal Business Name): FOOTPRINTS PODIATRIC MEDICINE & SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 MEDICAL DR STE 107
SAN ANTONIO TX
78229-6023
US

IV. Provider business mailing address

5282 MEDICAL DR STE 107
SAN ANTONIO TX
78229-6023
US

V. Phone/Fax

Practice location:
  • Phone: 210-949-1500
  • Fax: 210-949-1490
Mailing address:
  • Phone: 210-949-1500
  • Fax: 210-949-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1676
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1676
License Number StateTX

VIII. Authorized Official

Name: DR. JAMES MICHAEL BLUHM
Title or Position: OWNER
Credential: DPM
Phone: 210-949-1500