Provider Demographics
NPI:1285694851
Name:PECSON, EDILGRACE A (MD)
Entity type:Individual
Prefix:
First Name:EDILGRACE
Middle Name:A
Last Name:PECSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EDILGRACE
Other - Middle Name:A
Other - Last Name:PECSON PHIPPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1005 W RALPH HALL PKWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6658
Mailing Address - Country:US
Mailing Address - Phone:972-772-3100
Mailing Address - Fax:214-520-7120
Practice Address - Street 1:1005 W RALPH HALL PKWY
Practice Address - Street 2:SUITE 135
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6658
Practice Address - Country:US
Practice Address - Phone:972-772-3100
Practice Address - Fax:214-520-7120
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177973803Medicaid
I38297Medicare UPIN