Provider Demographics
NPI:1871539007
Name:HENKE, JEFF SPOEDE (DPM)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:SPOEDE
Last Name:HENKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BUNTON CREEK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5701
Mailing Address - Country:US
Mailing Address - Phone:512-268-3668
Mailing Address - Fax:512-268-5785
Practice Address - Street 1:135 BUNTON CREEK RD STE 300
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5701
Practice Address - Country:US
Practice Address - Phone:512-268-3668
Practice Address - Fax:512-268-5785
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1769213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182589504Medicaid
TX182589504Medicaid
TX182589502Medicaid