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NPI Code Detail

MEDICARE: EXTANT PLLC

MEDICARE: EXTANT PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208VP0014XInterventional Pain Medicine Physician

General Provider Information

NPI Number : 1407555865
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXTANT PLLC
Provider Business Mailing Address
First Line : 3550 FM 1092 RD STE 200
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-2203
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3550 FM 1092 RD STE A
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-2203
Country : US
Telephone Number : 832-409-1460
Fax Number :
Authorized Official
Title or Position : OWNER/MD
Name : CHRISTIAN D PECCORA
Credential : MD
Telephone Number : 832-409-1460
Provider Enumeration Date : 02/24/2023
Last Update Date : 02/24/2023

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Directions to “EXTANT PLLC ” Practice Location

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