Organization
PEDIPLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY ROBINS (EXECUTIVE DIRECTOR)
(972) 436-7962
Entity
Organization
Contact information
Practice address
502 S OLD ORCHARD LN STE 126, LEWISVILLE, TX 75067-4374
(972) 436-7962
(972) 353-5780
Mailing address
502 S OLD ORCHARD LN STE 126, LEWISVILLE, TX 75067-4374
(972) 436-7962
(972) 353-5780
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
208000000X
Pediatrics Physician
—
—
363LP0200X
Pediatric Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091930001
—
TX
05
—
091930002
—
TX
Enumeration date
04/02/2007
Last updated
07/11/2023
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