Provider Demographics
NPI:1073912325
Name:PEDIATRIC ENDOCRINOLOGY CLINIC
Entity Type:Organization
Organization Name:PEDIATRIC ENDOCRINOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-287-0459
Mailing Address - Street 1:4302 S SUGAR RD STE 205
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9140
Mailing Address - Country:US
Mailing Address - Phone:956-287-0459
Mailing Address - Fax:956-287-0476
Practice Address - Street 1:4302 S SUGAR RD STE 205
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9140
Practice Address - Country:US
Practice Address - Phone:956-287-0459
Practice Address - Fax:956-287-0476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OTTO VELASQUEZ MDPHD & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP87762080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty