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General NPI Number Information
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NPI Number | 1902380009
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Entity Type | Organization
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Legal Business Name | PELICAN MEDICAL SPECIALISTS PLLC
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 931 STATE HIGHWAY 121 STE 1100
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City | ALLEN
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State | TX
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Zip | 75013-1180
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Country | US
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Telephone | 972-674-9910
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Fax | 972-666-5166
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Provider Business Mailing Address
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Address Line | 1022 KENILWORTH ST
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City | ALLEN
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State | TX
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Zip | 75013-5828
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Country | US
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Telephone | 972-674-9910
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Fax | 972-666-5166
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Authorized Official
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Title or Position | DIRECTOR
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Name | MOHAMMED MOIZUDDIN
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Credential |
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Telephone | 972-674-9910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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