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General NPI Number Information
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NPI Number | 1487072047
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Entity Type | Organization
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Legal Business Name | BAYSHORE AREA PEDIATRIC CLINIC, PA
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 3325 PLAINVIEW ST SUITE C-9
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City | PASADENA
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State | TX
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Zip | 77504-1989
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Country | US
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Telephone | 713-830-2996
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Fax | 713-830-2998
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Provider Business Mailing Address
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Address Line | 3325 PLAINVIEW ST SUITE C-9
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City | PASADENA
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State | TX
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Zip | 77504-1989
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Country | US
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Telephone | 713-830-2996
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Fax | 713-830-2998
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. OTTO H KIEFFER
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Credential | MD
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Telephone | 713-830-2996
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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 | K1505
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License Number State | TX
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