Provider Demographics
NPI:1043551591
Name:GRAND PRAIRIE PEDIATRICS
Entity Type:Organization
Organization Name:GRAND PRAIRIE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DEAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZUBIALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-271-1515
Mailing Address - Street 1:1122 NE 13TH ST
Mailing Address - Street 2:ORI 274
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1039
Mailing Address - Country:US
Mailing Address - Phone:405-271-1515
Mailing Address - Fax:405-271-1001
Practice Address - Street 1:7301 N COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-6646
Practice Address - Country:US
Practice Address - Phone:405-721-8090
Practice Address - Fax:405-722-8529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA-OU PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-08
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care