Basic Information
| Provider Information | |||||||||
| NPI: | 1851635452 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC PARTNERS OF AUSTIN, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 678053 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752678053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122410546 | ||||||||
| FaxNumber: | 5122410937 | ||||||||
| Practice Location | |||||||||
| Address1: | 3410 FAR WEST BLVD STE 130 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787313167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123456758 | ||||||||
| FaxNumber: | 5123451469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | TERWELP | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5123456758 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.