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General NPI Number Information
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NPI Number | 1699812552
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Entity Type | Organization
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Legal Business Name | DECATUR LITTLE EAGLE PEDIATRICS, P.A.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 2401 S FM 51 SUITE 100
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City | DECATUR
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State | TX
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Zip | 76234-3781
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Country | US
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Telephone | 940-627-8044
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Fax | 940-627-8055
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Provider Business Mailing Address
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Address Line | 2401 S FM 51 SUITE 100
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City | DECATUR
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State | TX
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Zip | 76234-3781
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Country | US
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Telephone | 940-627-8044
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Fax | 940-627-8055
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | AMANDA LOVETTE
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Credential | MD
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Telephone | 940-627-8044
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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 | K2797
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License Number State | TX
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