Healthcare Provider Details

I. General information

NPI: 1073912325
Provider Name (Legal Business Name): PEDIATRIC ENDOCRINOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 S SUGAR RD STE 205
EDINBURG TX
78539-9140
US

IV. Provider business mailing address

4302 S SUGAR RD STE 205
EDINBURG TX
78539-9140
US

V. Phone/Fax

Practice location:
  • Phone: 956-287-0459
  • Fax: 956-287-0476
Mailing address:
  • Phone: 956-287-0459
  • Fax: 956-287-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberP8776
License Number StateTX

VIII. Authorized Official

Name: DR. JOSE D GAMEZ
Title or Position: MD
Credential: M.D.
Phone: 956-287-0459