Healthcare Provider Details

I. General information

NPI: 1205194263
Provider Name (Legal Business Name): DAVID A. ANDREONE DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 SHILOH ROAD STE C110
TYLER TX
75703-1406
US

IV. Provider business mailing address

921 SHILOH ROAD STE C110
TYLER TX
75703-1406
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-2858
  • Fax: 903-595-6970
Mailing address:
  • Phone: 903-595-2858
  • Fax: 903-595-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1481
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID A ANDREONE
Title or Position: OWNER/PODIATRIST
Credential: DPM
Phone: 903-595-2858