Provider Demographics
NPI:1457468373
Name:WYOMING SPRINGS PEDIATRIACS
Entity Type:Organization
Organization Name:WYOMING SPRINGS PEDIATRIACS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DE HARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-244-5959
Mailing Address - Street 1:7200 WYOMING SPGS
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4303
Mailing Address - Country:US
Mailing Address - Phone:512-244-5959
Mailing Address - Fax:512-244-1156
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-244-5959
Practice Address - Fax:512-244-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5302208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083727259OtherNPI - DR. DE HARO
TX1982717179OtherNPI - DR. MARSHALL