# FALLEN TREE CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841467727
- **Authorized official:** DR. PEYTON THOMPSON MD (OWNER, PRESIDENT)
- **Authorized official phone:** (512) 760-0666

## Contact information

- **Practice address:** 11416 RUNNEL RIDGE RD, MANOR, TX 78653-3874
- **Practice address phone:** (512) 760-0666
- **Practice address fax:** (866) 265-1725
- **Mailing address:** 11416 RUNNEL RIDGE RD, MANOR, TX 78653-3874
- **Mailing address phone:** (512) 760-0666
- **Mailing address fax:** (866) 265-1725

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | DD9687 | TX | — |
| 207Q00000X | Family Medicine Physician | DD9687 | TX | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | D9687 | TX | Yes |

## Other

- **Enumeration date:** 05/10/2008
- **Last updated:** 09/06/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 197360401 | — | TX |