Unknown Individual – Developmental - Behavioral Pediatrics Physician, NPI 1366408890

Developmental - Behavioral Pediatrics Physician

Unknown Individual is a healthcare provider. based in Lubbock, Texas. specializing in Developmental - Behavioral Pediatrics Physician. They hold a License No. K5680 (TX). The NPI Number for Unknown Individual is 1366408890

Main info

Organization

Inactive

29 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1366408890

Phone

(806) 761-0333

Address

5219 CITY BANK PKWY STE 35

Deactivation Date

20 April 2022

Doctor Profile

Medical School Name

TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER SCHOOL OF MEDICINE

Secondary Phone

8062819966

Graduation Year

1997 (29 years ago)

PAC ID

5799826582

Group Practice PAC ID

7810157641

Professional Enrollment ID

I20091230000263

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience19

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

City Bank Parkway, Lubbock, Lubbock County, Texas, 79414, United States
LUBBOCK, TX 79407
Phone: (806) 761-0333
Fax: (806) 782-0097
Type: Mailing
S.A. Hale Jr., M.D. & D.A. Laurentz, M.D., 6809, Slide Road, Lubbock, Lubbock County, Texas, 79424, United States
LUBBOCK, TX 794241517
Phone: (806) 771-7257
Fax: (806) 788-0853
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 79407)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 7810157641View full group profile

Name	Specialty	State
PATRICIA ANN PEREZ (MSN,APRN,FNP-BC)	-	TX
JOAN GRAVES-MCPHERSON (FNP)	-	TX

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?

You can start verification with NPI 1366408890 for Unknown Individual, then check state licensing separately.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What is Unknown Individual's primary classification?

Developmental - Behavioral Pediatrics Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.

Where should I expect Unknown Individual on a map?

Expect Lubbock, Texas as a primary anchor for Unknown Individual unless the record lists multiple sites.

Why does Unknown Individual have multiple addresses?

2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.