Provider Demographics
NPI:1619383650
Name:PEDIATRIC AND ADULT RECONSTRUCTIVE CENTER FOR UROLOGY, PLLC
Entity Type:Organization
Organization Name:PEDIATRIC AND ADULT RECONSTRUCTIVE CENTER FOR UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-618-4405
Mailing Address - Street 1:5680 FRISCO SQUARE BLVD
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3308
Mailing Address - Country:US
Mailing Address - Phone:214-618-4405
Mailing Address - Fax:
Practice Address - Street 1:5680 FRISCO SQUARE BLVD
Practice Address - Street 2:SUITE 2300
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3308
Practice Address - Country:US
Practice Address - Phone:214-618-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty