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General NPI Number Information
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NPI Number | 1952727109
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Entity Type | Organization
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Legal Business Name | FIREFLY PEDIATRICS, PLLC
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 2148 JACKSON KELLER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2722
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Country | US
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Telephone | 210-501-0703
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Fax | 210-526-0334
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Provider Business Mailing Address
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Address Line | 2148 JACKSON KELLER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2722
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Country | US
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Telephone | 210-501-0703
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Fax | 210-526-0334
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL LEE SEGURA
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Credential | MBA
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Telephone | 512-940-1027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | P3769
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P3769
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License Number State | TX
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