Healthcare Provider Details

I. General information

NPI: 1235978263
Provider Name (Legal Business Name): TEDDY BEAR PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 RONALD W REAGAN BLVD UNIT 405
CEDAR PARK TX
78641-2541
US

IV. Provider business mailing address

1100 DRY CREEK CV
CEDAR PARK TX
78613-6970
US

V. Phone/Fax

Practice location:
  • Phone: 512-931-1575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAIMIN MAGANBHAI PATEL
Title or Position: MEMBER
Credential: MD
Phone: 512-931-1575