Provider Demographics
NPI:1700207321
Name:HUEBNER PEDIATRICS
Entity Type:Organization
Organization Name:HUEBNER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELNERY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-447-3000
Mailing Address - Street 1:15714 HUEBNER RD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-0997
Mailing Address - Country:US
Mailing Address - Phone:210-447-3000
Mailing Address - Fax:210-447-3000
Practice Address - Street 1:15714 HUEBNER RD BLDG 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0997
Practice Address - Country:US
Practice Address - Phone:210-447-3000
Practice Address - Fax:210-447-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1452208000000X
TXM0579208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120641904Medicaid
TX120641901Medicaid