| NPI | 1861500522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIE SLATTERY Administrator 979-836-6153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX E2546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G5283) |
| 208000000X Pediatrics (Licence: TX F3730) | |
| 208000000X Pediatrics (Licence: TX K6753) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-10-27 |