Healthcare Provider Details

I. General information

NPI: 1447554860
Provider Name (Legal Business Name): PEDIATRIC ENDOCRINOLOGY OF CENTRAL TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605A REDWOOD ROAD
SAN MARCOS TX
78666-1424
US

IV. Provider business mailing address

7716 TRAILSIDE ESTATES BOULEVARD
AUSTIN TX
78724-6381
US

V. Phone/Fax

Practice location:
  • Phone: 512-287-1289
  • Fax: 512-276-1543
Mailing address:
  • Phone: 512-287-1289
  • Fax: 512-276-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberL7165
License Number StateTX

VIII. Authorized Official

Name: DR. ROSE LINDA SCHNEIER
Title or Position: PHYSICIAN
Credential: MD
Phone: 512-287-1289