Provider Demographics
NPI:1720100951
Name:STONE OAK PEDIATRICS, PA
Entity Type:Organization
Organization Name:STONE OAK PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-403-2229
Mailing Address - Street 1:540 OAK CENTRE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3936
Mailing Address - Country:US
Mailing Address - Phone:210-403-2229
Mailing Address - Fax:210-403-2524
Practice Address - Street 1:540 OAK CENTRE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3936
Practice Address - Country:US
Practice Address - Phone:210-403-2229
Practice Address - Fax:210-403-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER