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General NPI Number Information
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NPI Number | 1215268776
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Entity Type | Organization
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Legal Business Name | PEGASUS PEDIATRICS PA
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Dates
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Enumeration Date | 01/23/2010
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Last Update Date | 01/23/2010
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Provider Practice Location Address
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Address Line | 6406 N NEW BRAUNFELS AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3827
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Country | US
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Telephone | 215-584-5780
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Fax | 516-214-8751
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Provider Business Mailing Address
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Address Line | 2810 THOUSAND OAKS DR #165
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City | SAN ANTONIO
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State | TX
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Zip | 78232-4108
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Country | US
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Telephone | 210-912-8395
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Fax | 516-214-8751
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN LIGHTFOOT SMITH
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Credential | MD
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Telephone | 215-584-5780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M9015
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License Number State | TX
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