Provider Demographics
NPI:1245434661
Name:STONEBRIAR PEDIATRICS, P.A.
Entity type:Organization
Organization Name:STONEBRIAR PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAI
Authorized Official - Middle Name:VINH
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-668-7110
Mailing Address - Street 1:3550 PARKWOOD BLVD
Mailing Address - Street 2:SUITE C-306
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1903
Mailing Address - Country:US
Mailing Address - Phone:972-668-7110
Mailing Address - Fax:972-668-7135
Practice Address - Street 1:3550 PARKWOOD BLVD
Practice Address - Street 2:SUITE C-306
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1903
Practice Address - Country:US
Practice Address - Phone:972-668-7110
Practice Address - Fax:972-668-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH43150Medicare UPIN