MEDICARE: NUBY PEDIATRICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10046727	OTHER	TX	AMERIGROUP
3	0011NJ	OTHER	TX	BCBSTX
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356396980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUBY PEDIATRICS PA

Provider Business Mailing Address
First Line	:	1208 BENT OAKS CT
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-3300
Country	:	US
Telephone Number	:	940-566-5437
Fax Number	:	940-323-0553

Provider Business Practice Location Address
First Line	:	1208 BENT OAKS CT
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-3300
Country	:	US
Telephone Number	:	940-566-5437
Fax Number	:	940-323-0553

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LISA RODRIGUEZ
Credential	:
Telephone Number	:	940-566-5437

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	05/07/2024

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Directions to “NUBY PEDIATRICS PA ” Practice Location

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