=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306088562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID LECUSAY PEDIATRICS P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2009
-----------------------------------------------------
Last Update Date | 07/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 864 CENTRAL BLVD SUITE 2700
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-7551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-544-6900
-----------------------------------------------------
Fax | 956-544-6905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 864 CENTRAL BLVD SUITE 2700
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-7551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-544-6900
-----------------------------------------------------
Fax | 956-544-6905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD / PRESIDENT
-----------------------------------------------------
Name | DR. DAVID LECUSAY
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 956-544-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | L9777
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------