Provider Demographics
NPI:1073802724
Name:PECAN TREE PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:PECAN TREE PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-772-3100
Mailing Address - Street 1:1005 W RALPH HALL PKWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6658
Mailing Address - Country:US
Mailing Address - Phone:972-772-3100
Mailing Address - Fax:214-520-7120
Practice Address - Street 1:1005 W RALPH HALL PKWY
Practice Address - Street 2:SUITE 135
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6658
Practice Address - Country:US
Practice Address - Phone:972-772-3100
Practice Address - Fax:214-520-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9870208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty