EAST TEXAS PODIATRY ASSOCIATES, P.C. (NPI# 1225137185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225137185 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS PODIATRY ASSOCIATES, P.C. |
| Practice Address |
1028 E Idel Suite A Tyler TX 75701 |
| Practice Telephone | 9035931749 |
| Practice Fax Number | 9035931487 |
| Mailing Telephone | 9035931749 |
| Mailing Fax Number | 9035931487 |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2009-03-03 |
| Authorized Official Name | DR. ROBERT A BOUDREAU (OWNER) |
| Authorized Official Telephone | 9035931749 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | RAILROAD MEDICARE | 480028507 | 01 |
| TX | PALMETTO DME | 5594780001 | 01 |
| Street Address |
1028 E IDEL SUITE A |
| City | TYLER |
| State | TX |
| Zip Code | 75701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326147281 | Robert A Boudreau | Podiatrist | 1028 E Idel, Suite A, Tyler, TX 75701 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992075063 | Anderson Podiatry Pllc | Podiatrist | 1407 S Fleishel Ave Ste 301, Tyler, TX 75701-3388 | 2012-01-06 |
| 1710276662 | East Texas Foot and Ankle Centers, Pa | Podiatrist | 6603 Oak Hill Blvd, Tyler, TX 75703-0586 | 2011-03-31 |
| 1104125780 | Keith Robert Crandall | Podiatrist | 9209 Stonebank Xing, Tyler, TX 75703-0829 | 2011-03-21 |
| 1689902918 | James Edward Kent | Podiatrist | 6603 Oak Hill Blvd., Tyler, TX 75703-3604 | 2009-11-24 |
| 1285644302 | Evangela L Anderson | Podiatrist | 1407 S Fleishel Ave, Ste. 301, Tyler, TX 75701-3388 | 2006-08-09 |
| 1164468344 | Dustin Wade Smith | Podiatrist | 1761 Troup Hwy, Tyler, TX 75701-5869 | 2006-06-22 |
| 1801407887 | Greater Foundation Foot Clinics East Texas, Pllc | Podiatrist | 1761 Troup Hwy, Tyler, TX 75701-5869 | 2020-08-12 |
| 1437693330 | Kati Elizabeth Waters | Podiatrist | 6603 Oak Hill Blvd, Tyler, TX 75703-0586 | 2016-12-12 |
| 1730530924 | Sharon Overall | Podiatrist | 6603 Oak Hill Blvd, Tyler, TX 75703-0586 | 2016-06-29 |
| 1891920583 | Matthew Owen Kindle | Podiatrist | 5826 New Copeland Rd, Tyler, TX 75703-6217 | 2009-05-25 |
| Find all providers in TYLER | ||||
Please comment or provide details below to improve the information on EAST TEXAS PODIATRY ASSOCIATES, P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.