Provider Demographics
NPI:1528230331
Name:DENTON PEDIATRIC PHYSICIANS PLLC
Entity Type:Organization
Organization Name:DENTON PEDIATRIC PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-401-8720
Mailing Address - Street 1:3537 S I-35 E
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6800
Mailing Address - Country:US
Mailing Address - Phone:940-565-1222
Mailing Address - Fax:940-565-1220
Practice Address - Street 1:3537 S I-35 E
Practice Address - Street 2:SUITE 207
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6800
Practice Address - Country:US
Practice Address - Phone:940-565-1222
Practice Address - Fax:940-565-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003RHOtherBLUE CROSS BLUE SHIELD
TX194449801Medicaid
TX00Z082Medicare PIN