Individual
DR. LAWRENCE ALLEN CZELUSTA I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
8601 VILLAGE DR STE 104, SAN ANTONIO, TX 78217-5509
(210) 656-6383
(210) 967-5766
Mailing address
9325 SCHOENTHAL RD, SAN ANTONIO, TX 78266-2858
(210) 656-6383
(210) 651-9097
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
633
TX
213ES0000X
Sports Medicine Podiatrist
633
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00FF35
BCBS PROVIDER NUMBER
TX
01
—
333800YX2Y
PTAN
TX
Enumeration date
11/09/2006
Last updated
03/14/2014
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