Provider Demographics
NPI:1558549162
Name:PEDIATRIC MEDICINE, P.A.
Entity Type:Organization
Organization Name:PEDIATRIC MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:OZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-2500
Mailing Address - Street 1:7922 EWING HALSELL DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3786
Mailing Address - Country:US
Mailing Address - Phone:210-614-2500
Mailing Address - Fax:210-614-2755
Practice Address - Street 1:7922 EWING HALSELL DR
Practice Address - Street 2:SUITE 440
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3786
Practice Address - Country:US
Practice Address - Phone:210-614-2500
Practice Address - Fax:210-614-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty