MEDICARE: TEXAS PEDIATRIC PULMONARY CONSULTANTS, P.A.

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
1	2080P0214X	Pediatric Pulmonology Physician	L6308	TX

General Provider Information

NPI Number	:	1134310642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS PEDIATRIC PULMONARY CONSULTANTS, P.A.

Provider Business Mailing Address
First Line	:	2251 W ELDORADO PKWY
Second Line	:	SUITE 100
City	:	MCKINNEY
State	:	TX
Zip	:	75070-4358
Country	:	US
Telephone Number	:	972-562-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 W ELDORADO PKWY
Second Line	:	SUITE 100
City	:	MCKINNEY
State	:	TX
Zip	:	75070-4358
Country	:	US
Telephone Number	:	972-562-1188
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAYRA S. BUSTILLO
Credential	:	MD
Telephone Number	:	972-562-1188

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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