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General NPI Number Information
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NPI Number | 1225761166
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Entity Type | Organization
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Legal Business Name | PREMIER PODIATRY
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Dates
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Enumeration Date | 07/07/2022
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 4422 PACK SADDLE PASS
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City | AUSTIN
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State | TX
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Zip | 78745-1681
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Country | US
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Telephone | 814-636-7736
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Fax |
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Provider Business Mailing Address
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Address Line | 4422 PACK SADDLE PASS
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City | AUSTIN
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State | TX
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Zip | 78745-1681
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Country | US
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Telephone | 814-636-7736
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Fax |
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Authorized Official
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Title or Position | OWNER, AUTHORIZED OFFICIAL
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Name | DR. JEFFREY SCOTT D'ALESSANDRO
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Credential | DPM
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Telephone | 512-649-7442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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