Healthcare Provider Details

I. General information

NPI: 1306903216
Provider Name (Legal Business Name): KIDS DOC'S PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 W PARKER RD SUITE 400
PLANO TX
75093-7901
US

IV. Provider business mailing address

6130 W PARKER RD SUITE 400
PLANO TX
75093-7901
US

V. Phone/Fax

Practice location:
  • Phone: 972-608-0200
  • Fax: 972-608-0617
Mailing address:
  • Phone: 972-608-0200
  • Fax: 972-608-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberF4005
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberF4402
License Number StateTX

VIII. Authorized Official

Name: DR. ANNA M GOMEZ
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 972-608-0200