Basic Information
| Provider Information | |||||||||
| NPI: | 1962454595 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLINIC FOR PAIN MANAGEMENT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTER FOR PAIN RELIEF | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9080 HARRY HINES BLVD | ||||||||
| Address2: | STE 110 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146370887 | ||||||||
| FaxNumber: | 8175168444 | ||||||||
| Practice Location | |||||||||
| Address1: | 9080 HARRY HINES BLVD | ||||||||
| Address2: | STE 110 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146370887 | ||||||||
| FaxNumber: | 8175168444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAMIREZ | ||||||||
| AuthorizedOfficialFirstName: | MANUEL | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2146370887 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.