Lake Area Pediatrics

NPI 1285645911 - Pediatrics - 208000000X

NPI Details
NPI 1285645911
Enumeration Date 08/10/2006
Last Updated 01/06/2011
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name JACK S JACK
Position OWNER
Phone (936) 582-5620
Fax (936) 582-5621
Practice Location
18057 HWY 105 WEST
STE. 220
MONTGOMERY TX, 77356, US
Phone (936) 582-5620
Fax (936) 582-5621
Business Location
18057 HWY 105 WEST
STE. 220
MONTGOMERY TX, 77356, US
Phone (936) 582-5620
Fax (936) 582-5621
Toxanomy
Taxonomy Code 208000000X
License State Texas
License Number L3800
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According to our database, Lake Area Pediatrics NPI is 1285645911, taxonomy code is 208000000X and license number is L3800, license state is located at Texas. Lake Area Pediatrics physically located at 18057 Hwy 105 West, Montgomery TX, 77356. NPI Number 1033115704 has the healthcare provider type.

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1285645911 NPI number is provided on an as is basis without warranty of any kind. 1285645911 is maintained by the National Plan & Provider Enumeration System. The contents of Lake Area Pediatrics are for informational purposes only.