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Individual

DR. LAWRENCE ALLEN CZELUSTA I

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

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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