Provider Demographics
NPI:1699132381
Name:STEPHEN'S PEDI & PULMONARY PRACTICE, PA
Entity type:Organization
Organization Name:STEPHEN'S PEDI & PULMONARY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-231-0207
Mailing Address - Street 1:209 W 2ND ST
Mailing Address - Street 2:UNIT 201
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3021
Mailing Address - Country:US
Mailing Address - Phone:682-231-0207
Mailing Address - Fax:817-922-0805
Practice Address - Street 1:900 JEROME ST
Practice Address - Street 2:102
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3945
Practice Address - Country:US
Practice Address - Phone:682-231-0207
Practice Address - Fax:817-922-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty