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General NPI Number Information
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NPI Number | 1992988661
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Entity Type | Organization
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Legal Business Name | MEYNARD M. NUSSBAUM DPM PA
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 2500 FONDREN ROAD SUITE 255
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City | HOUSTON
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State | TX
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Zip | 77063-2313
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Country | US
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Telephone | 713-781-0019
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Fax | 713-781-1112
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Provider Business Mailing Address
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Address Line | 2500 FONDREN ROAD SUITE 255
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City | HOUSTON
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State | TX
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Zip | 77063-2313
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Country | US
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Telephone | 713-781-0019
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Fax | 713-781-1112
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Authorized Official
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Title or Position | PRESIDENT
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Name | MEYNARD MORRIE NUSSBAUM
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Credential | DPM PA
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Telephone | 713-781-0019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0456
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License Number State | TX
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