Provider Demographics
NPI:1871872770
Name:TIGER PEDIATRICS LLC
Entity type:Organization
Organization Name:TIGER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PECORAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-777-7627
Mailing Address - Street 1:303 N KEENE ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7193
Mailing Address - Country:US
Mailing Address - Phone:573-777-7627
Mailing Address - Fax:573-777-4596
Practice Address - Street 1:303 N KEENE ST
Practice Address - Street 2:SUITE 404
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7193
Practice Address - Country:US
Practice Address - Phone:573-777-7627
Practice Address - Fax:573-777-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty