Organization
FREDERICKSBURG PULMONARY ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH TERRELL M.D. (PRESIDENT)
(830) 997-1010
Entity
Organization
Contact information
Practice address
205 WEST WINDCREST, SUITE 340, FREDERICKSBURG, TX 78624
(830) 997-1010
(830) 997-1076
Mailing address
205 WEST WINDCREST, SUITE 340, FREDERICKSBURG, TX 78624
(830) 997-1010
(830) 997-1076
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0038NC
BLUE CROSS BLUE SHIELD
TX
05
—
179077601
—
TX
01
—
DE6018
RAILROAD MEDICARE PART B
TX
Enumeration date
08/05/2006
Last updated
10/25/2007
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