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General NPI Number Information
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NPI Number | 1073802724
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Entity Type | Organization
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Legal Business Name | PECAN TREE PEDIATRICS, P.A.
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 201 E I30 STE 100
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City | ROCKWALL
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State | TX
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Zip | 75087-5402
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Country | US
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Telephone | 972-772-3100
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Fax | 469-757-4890
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Provider Business Mailing Address
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Address Line | 201 E I30 STE 100
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City | ROCKWALL
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State | TX
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Zip | 75087-5402
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Country | US
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Telephone | 972-772-3100
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Fax | 469-757-4890
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CASEY ELLEN DRAKE
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Credential | M.D.
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Telephone | 972-772-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J9870
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License Number State | TX
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