Organization
PEGASUS PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN LIGHTFOOT SMITH MD (PRESIDENT)
(215) 584-5780
Entity
Organization
Contact information
Practice address
6406 N NEW BRAUNFELS AVE, SAN ANTONIO, TX 78209-3827
(215) 584-5780
(516) 214-8751
Mailing address
2810 THOUSAND OAKS DR, #165, SAN ANTONIO, TX 78232-4108
(210) 912-8395
(516) 214-8751
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M9015
TX
Other
Enumeration date
01/23/2010
Last updated
01/23/2010
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