MEDICARE: SPUR PODIATRY

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1578363164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPUR PODIATRY

Provider Business Mailing Address
First Line	:	625 PARKVIEW DR STE 102
Second Line	:
City	:	TROPHY CLUB
State	:	TX
Zip	:	76262-4204
Country	:	US
Telephone Number	:	817-527-6537
Fax Number	:	469-620-7558

Provider Business Practice Location Address
First Line	:	625 PARKVIEW DR STE 102
Second Line	:
City	:	TROPHY CLUB
State	:	TX
Zip	:	76262-4204
Country	:	US
Telephone Number	:	817-527-6537
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY FISHMAN
Credential	:	DPM
Telephone Number	:	817-527-6537

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	06/26/2025

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Directions to “SPUR PODIATRY ” Practice Location

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