Healthcare Provider Details

I. General information

NPI: 1437594017
Provider Name (Legal Business Name): V & M PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12005 BEE CAVE RD SUITE 2A
BEE CAVE TX
78738
US

IV. Provider business mailing address

12005 BEE CAVE RD SUITE 2A
BEE CAVE TX
78738
US

V. Phone/Fax

Practice location:
  • Phone: 512-921-8404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN5888
License Number StateTX

VIII. Authorized Official

Name: DR. JESSICA MORGAN
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 512-921-8404