Provider Demographics
NPI:1306088562
Name:DAVID LECUSAY PEDIATRICS P A
Entity type:Organization
Organization Name:DAVID LECUSAY PEDIATRICS P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LECUSAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-544-6900
Mailing Address - Street 1:864 CENTRAL BLVD
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7551
Mailing Address - Country:US
Mailing Address - Phone:956-544-6900
Mailing Address - Fax:956-544-6905
Practice Address - Street 1:864 CENTRAL BLVD
Practice Address - Street 2:SUITE 2700
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7551
Practice Address - Country:US
Practice Address - Phone:956-544-6900
Practice Address - Fax:956-544-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9777208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL9777OtherTEXAS STATE LICENSE
TX166514302Medicaid