Provider Demographics
NPI:1841207727
Name:TOTS AND TYKES PEDIATRICS PA
Entity Type:Organization
Organization Name:TOTS AND TYKES PEDIATRICS PA
Other - Org Name:PROFESSIONAL ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMUND
Authorized Official - Middle Name:MART
Authorized Official - Last Name:POQUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-652-3395
Mailing Address - Street 1:1500 OAKLAND PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-1550
Mailing Address - Country:US
Mailing Address - Phone:817-652-3395
Mailing Address - Fax:817-263-8878
Practice Address - Street 1:1500 OAKLAND PL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1550
Practice Address - Country:US
Practice Address - Phone:817-652-3395
Practice Address - Fax:817-263-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168720401Medicaid
G70058Medicare UPIN