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General NPI Number Information
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NPI Number | 1407555865
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Entity Type | Organization
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Legal Business Name | EXTANT PLLC
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 3550 FM 1092 RD STE A
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City | MISSOURI CITY
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State | TX
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Zip | 77459-2203
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Country | US
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Telephone | 832-409-1460
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Fax |
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Provider Business Mailing Address
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Address Line | 3550 FM 1092 RD STE 200
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City | MISSOURI CITY
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State | TX
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Zip | 77459-2203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MD
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Name | CHRISTIAN D PECCORA
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Credential | MD
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Telephone | 832-409-1460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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