=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154450856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEPHERD SQUARE PODIATRY,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2621 S SHEPHERD DR #220
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77098-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-942-7700
-----------------------------------------------------
Fax | 713-529-6527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2621 S SHEPHERD DR #220
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77098-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-942-7700
-----------------------------------------------------
Fax | 713-529-6527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTHONY J LAMARRA
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 713-942-7700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 1140
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------