Provider Demographics
NPI:1235765181
Name:PAEZ, PEDRO DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:DANIEL
Last Name:PAEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 MURPHY DR APT 704
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5912
Mailing Address - Country:US
Mailing Address - Phone:214-534-7665
Mailing Address - Fax:
Practice Address - Street 1:2208 MURPHY DR APT 704
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5912
Practice Address - Country:US
Practice Address - Phone:214-534-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138423208000000X
TXS9958208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics