Provider Demographics
NPI:1689862195
Name:PEDIATRIC NEUROLOGY, P.A.
Entity Type:Organization
Organization Name:PEDIATRIC NEUROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:ATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-776-9111
Mailing Address - Street 1:3704 CARLON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3702
Mailing Address - Country:US
Mailing Address - Phone:713-776-9111
Mailing Address - Fax:
Practice Address - Street 1:3704 CARLON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-3702
Practice Address - Country:US
Practice Address - Phone:713-776-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH52982084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty