Modern Pediatrics Professionals, Pllc

NPI #1154952505 in Austin, Texas

Provider Information

NPI Number: 1154952505
Entity Type: Organization
Organization Name: Modern Pediatrics Professionals, Pllc
Primary Specialty: Pediatrics
Enumeration Date: Feb 3, 2020
Last Updated: Feb 3, 2020

Practice Location

Address: 2309 SANTA MARIA ST
City: Austin
State: Texas
ZIP Code: 78702-4617
Phone: (319) 541-7604

Authorized Official

Name: DR. TIMOTHY JAMES PORTER, MD
Title: CHIEF MEDICAL OFFICER
Phone: (319) 541-7604

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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