# EDDIE DAVIS DPM PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780578872
- **Authorized official:** ROSALIE KREIGHBAUM (REGIONAL CREDENTIALING SPECIALIST)
- **Authorized official phone:** (314) 909-1920

## Contact information

- **Practice address:** 109 GALLERY CIR STE 119, SAN ANTONIO, TX 78258-3328
- **Practice address phone:** (210) 490-3668
- **Mailing address:** PO BOX 825159, PHILADELPHIA, PA 19182-5159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 06/04/2025
- **Last updated:** 06/04/2025