Organization
CAPITAL PEDIATRIC GROUP ASSOCIATES
Active
Other names
Capital Pediatric Group
Organization subpart
No
Provider details
NPI number
Authorized official
DOROTHY CAROLE CAMPBELL (CREDENTIALING SPECIALIST)
(512) 454-4545
Entity
Organization
Contact information
Practice address
1100 W 39TH 1/2 ST, AUSTIN, TX 78756-3902
(512) 454-4545
(512) 279-0445
Mailing address
1100 W 39TH 1/2 ST, AUSTIN, TX 78756-3902
(512) 454-4545
(512) 279-0445
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
E0921
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111533901
—
TX
Enumeration date
01/22/2007
Last updated
06/30/2014
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