Provider Demographics
NPI:1386793909
Name:EDDIE DAVIS, DPM, PLLC
Entity type:Organization
Organization Name:EDDIE DAVIS, DPM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPM
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-490-3668
Mailing Address - Street 1:109 GALLERY CIR STE 119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3328
Mailing Address - Country:US
Mailing Address - Phone:210-829-8770
Mailing Address - Fax:210-826-4864
Practice Address - Street 1:7424 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3254
Practice Address - Country:US
Practice Address - Phone:210-829-8770
Practice Address - Fax:210-826-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018792401Medicaid
TX018792401Medicaid
TX=========OtherTAX ID NUMBER
TX1093150001Medicare NSC
TX018792401Medicaid
TX1093150002Medicare NSC
TX1093150003Medicare NSC