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NPI Code Detail

MEDICARE: GRAND PRAIRIE PEDIATRICS

MEDICARE: GRAND PRAIRIE PEDIATRICS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1043551591
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRAND PRAIRIE PEDIATRICS
Provider Business Mailing Address
First Line : 1122 NE 13TH ST
Second Line : ORI 274
City : OKLAHOMA CITY
State : OK
Zip : 73117-1039
Country : US
Telephone Number : 405-271-1515
Fax Number : 405-271-1001
Provider Business Practice Location Address
First Line : 7301 N COMANCHE AVE
Second Line :
City : WARR ACRES
State : OK
Zip : 73132-6646
Country : US
Telephone Number : 405-721-8090
Fax Number : 405-722-8529
Authorized Official
Title or Position : EXECUTIVE DEAN
Name : JOHN P ZUBIALDE
Credential : MD
Telephone Number : 405-271-1515
Provider Enumeration Date : 03/08/2013
Last Update Date : 01/06/2020

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Directions to “GRAND PRAIRIE PEDIATRICS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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