Organization
KIDS CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM A FADER MD (PHYSICIAN)
(361) 994-7255
Entity
Organization
Contact information
Practice address
7017 S STAPLES ST, STE 101, CORPUS CHRISTI, TX 78413-5507
(361) 994-7255
(361) 994-7740
Mailing address
7017 S STAPLES ST, STE 101, CORPUS CHRISTI, TX 78413-5507
(361) 994-7255
(361) 994-7740
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
H3035
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121271401
—
TX
05
—
121271404
—
TX
Enumeration date
04/13/2007
Last updated
08/29/2013
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