Provider Demographics
NPI:1487917324
Name:GPK PEDIATRICS, PLLC
Entity type:Organization
Organization Name:GPK PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GUDRUN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:512-989-3334
Mailing Address - Street 1:103 S 12TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3960
Mailing Address - Country:US
Mailing Address - Phone:512-989-3334
Mailing Address - Fax:512-989-3390
Practice Address - Street 1:103 S 12TH ST
Practice Address - Street 2:STE 101
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3960
Practice Address - Country:US
Practice Address - Phone:512-989-3334
Practice Address - Fax:512-989-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680265363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX290264501Medicaid