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General NPI Number Information
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NPI Number | 1215581780
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Entity Type | Organization
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Legal Business Name | MAGNOLIA PEDIATRICS
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 2875 MAIN ST. SUITE 104
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City | FRISCO
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State | TX
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Zip | 75034
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Country | US
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Telephone | 214-872-1877
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Fax | 214-872-3114
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Provider Business Mailing Address
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Address Line | 1201 HOWELL ST
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City | MCKINNEY
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State | TX
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Zip | 75069
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Country | US
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Telephone | 208-830-1632
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | BRANDY NICOLE WELCH
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Credential | MD
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Telephone | 208-830-1632
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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 |
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License Number State |
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