Provider Demographics
NPI:1467119305
Name:PECUE-DRYSDALE, CRAIG (NREMT-P)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:PECUE-DRYSDALE
Suffix:
Gender:M
Credentials:NREMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 CADE LN NW
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-8121
Mailing Address - Country:US
Mailing Address - Phone:225-226-5440
Mailing Address - Fax:
Practice Address - Street 1:2178 CADE LN NW
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-8121
Practice Address - Country:US
Practice Address - Phone:225-226-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-28
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM5113122146L00000X, 146L00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX771197OtherEMS LICENSE