Lake Area Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

L3800 Issued in TX

Legal business name

LAKE AREA PEDIATRICS

Practice address

18057 Hwy 105 West
Ste. 220
Montgomery, TX 77356

Phone

(936) 582-5620

Fax

(936) 582-5621

NPI assigned

Aug 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jack S Robinson, MD

Title

Owner

Phone

(936) 582-5620

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294272000000",
    "number": "1285645911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18057 HWY 105 WEST",
            "address_2": "STE. 220",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "77356",
            "telephone_number": "936-582-5620",
            "fax_number": "936-582-5621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18057 HWY 105 WEST",
            "address_2": "STE. 220",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "77356",
            "telephone_number": "936-582-5620",
            "fax_number": "936-582-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE AREA PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2011-01-06",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-582-5620",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L3800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158814702",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1740276856",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jamie Narendra Kuda, PHARMD
• Wendy Kuo, OD
• Lake Area Emergency Center LLC
• Lake Conroe Counseling Center, PLLC
• Lake Conroe Physical Therapy and Rehabilitation Services, Inc.
• Lakeside Pharmacy LLC
• Lakeside Pharmacy LLC
• Lakeside Sleep Center LLC

• Pediatrics Physician in Montgomery, TX
• Providers in Montgomery, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.