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General NPI Number Information
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NPI Number | 1730364175
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Entity Type | Organization
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Legal Business Name | WEATHERFORD PEDIATRICS, P.A.
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 712 E ANDERSON ST SUITE A
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City | WEATHERFORD
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State | TX
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Zip | 76086-5873
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Country | US
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Telephone | 817-596-7717
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Fax | 817-596-7119
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Provider Business Mailing Address
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Address Line | 712 E ANDERSON ST SUITE A
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City | WEATHERFORD
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State | TX
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Zip | 76086-5873
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Country | US
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Telephone | 817-596-7717
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Fax | 817-596-7119
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN GAUNTT WALKER
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Credential | M.D.
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Telephone | 817-596-7717
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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 | H5445
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License Number State | TX
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