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General NPI Number Information
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NPI Number | 1497130751
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Entity Type | Organization
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Legal Business Name | DOMINIC ANSARI PEDIATRICS, PLLC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 2028 E BEN WHITE BLVD STE 240A
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City | AUSTIN
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State | TX
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Zip | 78741-6966
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Country | US
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Telephone | 832-930-1366
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Fax |
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Provider Business Mailing Address
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Address Line | 2028 E BEN WHITE BLVD STE 240-8801
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City | AUSTIN
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State | TX
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Zip | 78741-6966
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DOMINIC OMAR ANSARI
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Credential | M.D.
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Telephone | 832-930-1366
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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 | MD452657
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License Number State | PA
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