Basic Information
| Provider Information | |||||||||
| NPI: | 1245642313 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BREEZE PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 837 | ||||||||
| Address2: | |||||||||
| City: | HOWE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754590837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034872248 | ||||||||
| FaxNumber: | 9034872306 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N HIGHLAND AVE | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750927388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039577426 | ||||||||
| FaxNumber: | 9039577433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2014 | ||||||||
| LastUpdateDate: | 05/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | BREEZE | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9039577426 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, FAAP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | L6804 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 161041204 | 05 | TX | MEDICAID |