Provider Demographics
NPI:1104095363
Name:GERALD B MCCOOL DPM
Entity type:Organization
Organization Name:GERALD B MCCOOL DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MCCOOL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:915-581-1133
Mailing Address - Street 1:6955 N MESA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4442
Mailing Address - Country:US
Mailing Address - Phone:915-581-1133
Mailing Address - Fax:915-581-9656
Practice Address - Street 1:6955 N MESA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4442
Practice Address - Country:US
Practice Address - Phone:915-581-1133
Practice Address - Fax:915-581-9656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0916332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4643370001Medicare NSC