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General NPI Number Information
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NPI Number | 1619383650
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND ADULT RECONSTRUCTIVE CENTER FOR UROLOGY, PLLC
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 08/09/2025
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Provider Practice Location Address
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Address Line | 3716 STANDBRIDGE DRIVE # 200
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City | THE COLONY
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State | TX
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Zip | 75056
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Country | US
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Telephone | 214-618-4405
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Fax | 214-618-5506
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Provider Business Mailing Address
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Address Line | 3716 STANDBRIDGE DRIVE # 200
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City | THE COLONY
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State | TX
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Zip | 75056
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Country | US
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Telephone | 214-618-4405
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Fax | 214-618-5506
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Authorized Official
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Title or Position | OWNER
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Name | DR. WARREN SNODGRASS
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Credential | MD
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Telephone | 214-618-4405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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