East Texas Podiatry Associates, P.C.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

EAST TEXAS PODIATRY ASSOCIATES, P.C.

Practice address

1028 E Idel
Suite a
Tyler, TX 75701

Phone

(903) 593-1749

Fax

(903) 593-1487

NPI assigned

Sep 21, 2006

Last updated

Mar 3, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert A Boudreau, DPMNPI 1326147281

Title

Owner

Phone

(903) 593-1749

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert A Boudreau, DPM

  • Foot & Ankle Surgery Podiatrist
  • Tyler, TX
  • NPI 1326147281
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236038400000",
    "number": "1225137185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 E IDEL",
            "address_2": "SUITE A",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75701",
            "telephone_number": "903-593-1749",
            "fax_number": "903-593-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 E IDEL",
            "address_2": "SUITE A",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75701",
            "telephone_number": "903-593-1749",
            "fax_number": "903-593-1487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS PODIATRY ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2009-03-03",
        "status": "A",
        "authorized_official_last_name": "BOUDREAU",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-593-1749",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO DME",
            "identifier": "5594780001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480028507",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Texas Nephrology Association
• East Texas Neurology
• East Texas Omfs Trauma Consultants, PLLC
• East Texas Pediatric Rehabilitation Associates Inc (East Texas Children's Therapy Services)
• East Texas Physician Assistant Services
• East Texas Priority Medical Transportation LLC
• East Texas Psychiatry and Counseling PLLC
• East Texas Radiation Oncology, PA
• East Texas Spine Institute, PA
• East Texas Therapy and Rehab

• Foot & Ankle Surgery Podiatrist in Tyler, TX
• Providers in Tyler, TX by specialty
• Foot & Ankle Surgery Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.