Organization
PEDIAQ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED JOHNSON DO (MEDICAL DIRECTOR)
(214) 984-3900
Entity
Organization
Contact information
Practice address
10413 WALPOLE LN, AUSTIN, TX 78739-1553
(310) 713-4847
Mailing address
4849 GREENVILLE AVE STE 1225, DALLAS, TX 75206-4130
(214) 984-3900
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
AP81285
TX
Other
Enumeration date
08/12/2016
Last updated
08/12/2016
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