Provider Demographics
NPI:1154450856
Name:SHEPHERD SQUARE PODIATRY,P.A.
Entity type:Organization
Organization Name:SHEPHERD SQUARE PODIATRY,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-942-7700
Mailing Address - Street 1:2621 S SHEPHERD DR
Mailing Address - Street 2:#220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1515
Mailing Address - Country:US
Mailing Address - Phone:713-942-7700
Mailing Address - Fax:713-529-6527
Practice Address - Street 1:2621 S SHEPHERD DR
Practice Address - Street 2:#220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1515
Practice Address - Country:US
Practice Address - Phone:713-942-7700
Practice Address - Fax:713-529-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1140213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G96COtherBCBS
00847NMedicare ID - Type Unspecified