Provider Demographics
NPI:1790819993
Name:NEW BRAUNFELS PEDIATRIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NEW BRAUNFELS PEDIATRIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-625-9153
Mailing Address - Street 1:1535 EAST COMMON
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78103
Mailing Address - Country:US
Mailing Address - Phone:830-625-9153
Mailing Address - Fax:830-609-0572
Practice Address - Street 1:1535 EAST COMMON
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78103
Practice Address - Country:US
Practice Address - Phone:830-625-9153
Practice Address - Fax:830-609-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L31BOtherGROUP BCBS
TXL31BMedicare ID - Type UnspecifiedGROUP MEDICARE