MEDICARE: PODIATRY ASSOCIATES OF VICTORIA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	213EP1101X	Primary Podiatric Medicine Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB9630	OTHER	TX	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00920K	OTHER	TX	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1174505358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY ASSOCIATES OF VICTORIA PA

Provider Business Mailing Address
First Line	:	116 IMPERIAL DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-3948
Country	:	US
Telephone Number	:	361-578-2777
Fax Number	:	361-578-2778

Provider Business Practice Location Address
First Line	:	116 IMPERIAL DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-3948
Country	:	US
Telephone Number	:	361-578-2777
Fax Number	:	361-578-2778

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. MAUREEN LEIGH CALDWELL
Credential	:	DPM
Telephone Number	:	361-578-2777

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/19/2008

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Directions to “PODIATRY ASSOCIATES OF VICTORIA PA ” Practice Location

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