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General NPI Number Information
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NPI Number | 1104220573
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Entity Type | Organization
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Legal Business Name | CAVALIER JOY & CROWN PEDIATRIC SPECIALISTS, PLLC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 7002 LEBANON RD SUITE 103
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City | FRISCO
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State | TX
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Zip | 75034-7461
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Country | US
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Telephone | 469-213-7633
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Fax | 469-535-3664
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Provider Business Mailing Address
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Address Line | PO BOX 6023
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City | FRISCO
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State | TX
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Zip | 75035-0226
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Country | US
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Telephone | 469-213-7634
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Fax | 469-535-3664
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARYELLEN CAVALIER
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Credential | M.D.
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Telephone | 469-213-7634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | M9913
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | M9913
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | M9913
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License Number State | TX
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