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Organization
VILLAGE PEDIATRICS, PA
Active
Organization
VILLAGE PEDIATRICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE PERDUE MD (PRESIDENT)
(817) 249-4155
Entity
Organization
Contact information
Practice address
998 WINSCOTT RD, BENBROOK, TX 76126-2744
(817) 249-4155
(817) 249-0497
Mailing address
4917 RIVERBEND DR, FORT WORTH, TX 76109-2436
(817) 249-4155
(817) 249-0497
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K0154
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1331803-04
—
TX
05
—
1331803-06
—
TX
01
—
K0154
STATE MEDICAL LICENSE
TX
Enumeration date
07/02/2008
Last updated
07/02/2008
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