Provider Demographics
NPI:1801079579
Name:PEDIATRICS OF DALLAS
Entity type:Organization
Organization Name:PEDIATRICS OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-331-0567
Mailing Address - Street 1:PO BOX 4070
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-0070
Mailing Address - Country:US
Mailing Address - Phone:214-331-0567
Mailing Address - Fax:214-337-7779
Practice Address - Street 1:2301 S HAMPTON RD
Practice Address - Street 2:SUITE # 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1650
Practice Address - Country:US
Practice Address - Phone:214-331-0567
Practice Address - Fax:214-337-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142439203Medicaid
TX142439202Medicaid