Provider Demographics
NPI:1063514362
Name:VALENZA, J MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:J MICHAEL
Middle Name:
Last Name:VALENZA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:STE D204
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5248
Mailing Address - Country:US
Mailing Address - Phone:512-327-9251
Mailing Address - Fax:512-327-9742
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:STE D204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5248
Practice Address - Country:US
Practice Address - Phone:512-327-9251
Practice Address - Fax:512-327-9742
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXTX575213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX838463OtherPROVIDER #
TX00AP45OtherGROUP PTAN
TX838463OtherPROVIDER #