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General NPI Number Information
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NPI Number | 1104973171
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Entity Type | Organization
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Legal Business Name | CENTRAL TEXAS PEDIATRIC ENDOCRINOLOGY AND DIABETES, P.A.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3303 NORTHLAND DR SUITE 308
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City | AUSTIN
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State | TX
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Zip | 78731-4945
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Country | US
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Telephone | 512-467-9444
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Fax | 512-467-9550
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Provider Business Mailing Address
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Address Line | PO BOX 140494
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City | AUSTIN
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State | TX
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Zip | 78714-0494
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Country | US
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Telephone | 512-467-9444
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Fax | 512-467-9550
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY JANE WRAY
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Credential | M.D., PHD
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Telephone | 512-467-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | G4757
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License Number State | TX
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