Provider Demographics
NPI:1881736999
Name:SOUTHWEST PEDIATRIC ASSOCIATES OF SUGAR LAND, PA
Entity type:Organization
Organization Name:SOUTHWEST PEDIATRIC ASSOCIATES OF SUGAR LAND, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LA DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-494-2255
Mailing Address - Street 1:3521 TOWN CENTER BLVD S
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1285
Mailing Address - Country:US
Mailing Address - Phone:281-494-2255
Mailing Address - Fax:281-494-2266
Practice Address - Street 1:3521 TOWN CENTER BLVD S
Practice Address - Street 2:SUITE A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1285
Practice Address - Country:US
Practice Address - Phone:281-494-2255
Practice Address - Fax:281-494-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty