Provider Demographics
NPI:1699855270
Name:SAN ANGELO PEDIATRIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SAN ANGELO PEDIATRIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALDO
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:325-653-6944
Mailing Address - Street 1:314 E TWOHIG AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5502
Mailing Address - Country:US
Mailing Address - Phone:325-653-6944
Mailing Address - Fax:325-658-6500
Practice Address - Street 1:314 E TWOHIG AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5502
Practice Address - Country:US
Practice Address - Phone:325-653-6944
Practice Address - Fax:325-658-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD94922080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JT67OtherBLUE CROSS ID
TX00JT67Medicare ID - Type Unspecified
TX00JT67OtherBLUE CROSS ID