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General NPI Number Information
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NPI Number | 1285092619
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Entity Type | Organization
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Legal Business Name | PEDIATRICS & GENERAL PRACTICE, PLLC
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Dates
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Enumeration Date | 01/30/2016
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Last Update Date | 01/30/2016
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Provider Practice Location Address
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Address Line | 3626 N MACARTHUR BLVD SUITE 225
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City | IRVING
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State | TX
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Zip | 75062-3643
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Country | US
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Telephone | 256-226-9351
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Fax | 866-469-5182
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Provider Business Mailing Address
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Address Line | 7025 BENJAMIN WAY
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City | COLLEYVILLE
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State | TX
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Zip | 76034-1115
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Country | US
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Telephone | 256-226-9351
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Fax | 866-469-5182
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Authorized Official
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Title or Position | MEMBER
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Name | DR. IQBAL A. MEMON
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Credential | M.D.
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Telephone | 256-226-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | Q5039
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License Number State | TX
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