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NPI Code Detail

MEDICARE: COLLIN EUGENE PEHDE D.P.M.

MEDICARE: COLLIN EUGENE PEHDE D.P.M.
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
1213E00000XPodiatrist2166TX
2213ES0103XFoot & Ankle Surgery Podiatrist00782IA
3213ES0103XFoot & Ankle Surgery Podiatrist2166TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01045640OTHERIARR MEDICARE
6447448ZRNCOTHERTXMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
48FL880OTHERTXBLUE CROSS BLUE SHIELD OF TEXAS
51912278490OTHERIAWELLMARK BCBS

General Provider Information

NPI Number : 1740272491
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLIN EUGENE PEHDE D.P.M.
Provider Business Mailing Address
First Line : 701 S ZARZAMORA ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78207-5209
Country : US
Telephone Number : 210-358-7717
Fax Number : 210-358-7707
Provider Business Practice Location Address
First Line : 701 S ZARZAMORA ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78207-5209
Country : US
Telephone Number : 210-358-7717
Fax Number : 210-358-7707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 05/20/2022

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