Provider Demographics
NPI:1063260461
Name:WEATHERFORD PEDIATRICS AND FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:WEATHERFORD PEDIATRICS AND FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-550-6230
Mailing Address - Street 1:750 EUREKA ST
Mailing Address - Street 2:STE D
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086
Mailing Address - Country:US
Mailing Address - Phone:972-832-4218
Mailing Address - Fax:
Practice Address - Street 1:750 EUREKA ST
Practice Address - Street 2:STE D
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-550-6230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty