Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 142 | TX |
N | 222Z00000X | Podiatrist | 142 | TX |
Y | 224P00000X | Prosthetist | 142 | TX |
NPI | 1215160817 |
---|---|
Provider Name | Darren Poidevin |
First Address | San Antonio, TX 78229-3139 |
Second Address | San Antonio, TX 78229-3139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2009 |
Last Update Date | 13/09/2016 |