Provider Demographics
NPI:1750562591
Name:BLUEBONNET PODIATRY
Entity type:Organization
Organization Name:BLUEBONNET PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HAMNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-670-3900
Mailing Address - Street 1:1628 JERUSALEM DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-8620
Mailing Address - Country:US
Mailing Address - Phone:512-670-3900
Mailing Address - Fax:512-670-3900
Practice Address - Street 1:1628 JERUSALEM DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-8620
Practice Address - Country:US
Practice Address - Phone:512-670-3900
Practice Address - Fax:512-670-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1834213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty