Healthcare Provider Details

I. General information

NPI: 1346293800
Provider Name (Legal Business Name): SOUTHEAST ANESTHESIA & PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N BUCKNER BLVD STE 100
DALLAS TX
75218-3487
US

IV. Provider business mailing address

PO BOX 140105
DALLAS TX
75214-0105
US

V. Phone/Fax

Practice location:
  • Phone: 214-324-9400
  • Fax: 214-324-9402
Mailing address:
  • Phone: 214-324-9400
  • Fax: 214-324-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE ADOLFO DUARTE
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 214-324-9400