=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720268741
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOFFATT DAVID ADAMS JR. DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2007
-----------------------------------------------------
Last Update Date | 11/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16607 BLANCO RD STE 12205
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-497-4642
-----------------------------------------------------
Fax | 210-314-1375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19141 STONE OAK PKWY STE 104
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-3367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-497-4642
-----------------------------------------------------
Fax | 210-495-7245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 1845
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------