Provider Demographics
NPI:1285092619
Name:PEDIATRICS & GENERAL PRACTICE, PLLC
Entity type:Organization
Organization Name:PEDIATRICS & GENERAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:IQBAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-226-9353
Mailing Address - Street 1:7025 BENJAMIN WAY
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1115
Mailing Address - Country:US
Mailing Address - Phone:256-226-9351
Mailing Address - Fax:866-469-5182
Practice Address - Street 1:3626 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3643
Practice Address - Country:US
Practice Address - Phone:256-226-9351
Practice Address - Fax:866-469-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5039261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care