Healthcare Provider Details

I. General information

NPI: 1134577703
Provider Name (Legal Business Name): PEGASUS PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8604 GREENVILLE AVE STE 103A
DALLAS TX
75243-7148
US

IV. Provider business mailing address

8604 GREENVILLE AVE STE 103A
DALLAS TX
75243-7148
US

V. Phone/Fax

Practice location:
  • Phone: 214-702-5855
  • Fax: 877-244-9193
Mailing address:
  • Phone: 214-702-5855
  • Fax: 877-244-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALIK SAIDOV
Title or Position: OWNER
Credential: M.D.
Phone: 214-702-5855