Provider Demographics
NPI:1992067128
Name:EL PASO CHILDREN'S PHYSICIAN GROUP
Entity type:Organization
Organization Name:EL PASO CHILDREN'S PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-242-8600
Mailing Address - Street 1:5400 ALAMEDA AVE BLDG B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2914
Mailing Address - Country:US
Mailing Address - Phone:915-242-8402
Mailing Address - Fax:915-242-8406
Practice Address - Street 1:5400 ALAMEDA AVE BLDG B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2914
Practice Address - Country:US
Practice Address - Phone:915-242-8402
Practice Address - Fax:915-242-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty