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General NPI Number Information
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NPI Number | 1528050150
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Entity Type | Organization
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Legal Business Name | BEAR CREEK PEDIATRIC CLINIC PA
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4654 HWY 6 N STE 307
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City | HOUSTON
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State | TX
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Zip | 77084-2879
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Country | US
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Telephone | 281-463-9339
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Fax | 281-463-2921
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Provider Business Mailing Address
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Address Line | 4654 HWY 6 N STE 307
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City | HOUSTON
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State | TX
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Zip | 77084-2879
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Country | US
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Telephone | 281-463-9339
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Fax | 281-463-2921
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Authorized Official
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Title or Position | PRESIDENT DIRECTOR PEDIATRICIAN
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Name | SHOBHANA JAGAT KAMDAR
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Credential | MD
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Telephone | 281-463-9339
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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 | E 7433
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License Number State | TX
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