Basic Information
| Provider Information | |||||||||
| NPI: | 1003238056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC ENDOCRINOLOGY OF NORTH TEXAS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 SHAKESPEARE ST | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750104930 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6124 W PARKER RD | ||||||||
| Address2: | MEDICAL OFFICE BUILDING 3, SUITE #330 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406004861 | ||||||||
| FaxNumber: | 9406004866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2014 | ||||||||
| LastUpdateDate: | 12/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | BURTON | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | MATHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9406004861 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | N7403 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.