Organization
FALLEN TREE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PEYTON THOMPSON MD (OWNER, PRESIDENT)
(512) 760-0666
Entity
Organization
Contact information
Practice address
11416 RUNNEL RIDGE RD, MANOR, TX 78653-3874
(512) 760-0666
(866) 265-1725
Mailing address
11416 RUNNEL RIDGE RD, MANOR, TX 78653-3874
(512) 760-0666
(866) 265-1725
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
DD9687
TX
207Q00000X
Family Medicine Physician
DD9687
TX
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
D9687
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197360401
—
TX
Enumeration date
05/10/2008
Last updated
09/06/2023
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