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General NPI Number Information
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NPI Number | 1457567638
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PODIATRY, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 7425 FORBES BLVD SUITE 105
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City | LANHAM
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State | MD
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Zip | 20706-2220
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Country | US
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Telephone | 301-352-7756
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Fax | 301-352-7725
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Provider Business Mailing Address
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Address Line | 14300 GALLANT FOX LN STE 201
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City | BOWIE
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State | MD
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Zip | 20715-4033
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Country | US
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Telephone | 301-352-7756
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Fax | 301-352-7725
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Authorized Official
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Title or Position | OWNER
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Name | DR. VESTA D MCDOWELL
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Credential | DPM
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Telephone | 301-352-7756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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