MEDICARE: METROPLEX PEDIATRICS

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	K5093	TX

General Provider Information

NPI Number	:	1366639742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPLEX PEDIATRICS

Provider Business Mailing Address
First Line	:	6905 DAVIS BLVD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-4003
Country	:	US
Telephone Number	:	817-922-0800
Fax Number	:	817-922-0805

Provider Business Practice Location Address
First Line	:	6905 DAVIS BLVD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-4003
Country	:	US
Telephone Number	:	817-922-0800
Fax Number	:	817-922-0805

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	ABIMBOLA O DOSU
Credential	:
Telephone Number	:	817-922-0800

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	06/02/2024

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