Provider Demographics
NPI:1457773111
Name:BEAR PEDIATRIC PLLC
Entity Type:Organization
Organization Name:BEAR PEDIATRIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CMO
Authorized Official - Prefix:
Authorized Official - First Name:MARLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-901-9499
Mailing Address - Street 1:7254 BLANCO RD SUITE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:210-901-9499
Mailing Address - Fax:210-247-9499
Practice Address - Street 1:7254 BLANCO RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4930
Practice Address - Country:US
Practice Address - Phone:210-901-9499
Practice Address - Fax:210-247-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8044208000000X
261QU0200X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
346864OtherMEDICARE
TX336778101Medicaid