Healthcare Provider Details

I. General information

NPI: 1831519040
Provider Name (Legal Business Name): JONATHAN PAEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2014
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9915 BARKER CYPRESS RD STE 200
CYPRESS TX
77433-1203
US

IV. Provider business mailing address

9915 BARKER CYPRESS RD STE 200
CYPRESS TX
77433-1203
US

V. Phone/Fax

Practice location:
  • Phone: 281-737-1555
  • Fax: 281-737-1556
Mailing address:
  • Phone: 832-533-3730
  • Fax: 832-533-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberS0043
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberS0043
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: