Organization
GRANBURY PEDIATRICS & ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE CALCOTE (OFFICE MANAGER)
(817) 579-8687
Entity
Organization
Contact information
Practice address
805 PALUXY RD, GRANBURY, TX 76048-2329
(817) 579-8687
Mailing address
805 PALUXY RD, GRANBURY, TX 76048-2329
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K6711
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026584
—
TX
01
—
276279
SCOTT & WHITE
TX
01
—
7240025
AETNA
TX
01
—
82942Y
BCBS
TX
Enumeration date
05/08/2007
Last updated
08/22/2020
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