Healthcare Provider Details

I. General information

NPI: 1750604559
Provider Name (Legal Business Name): MINIMALLY INVASIVE SPINE INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N MACARTHUR BLVD SUITE 101
IRVING TX
75038-6497
US

IV. Provider business mailing address

4301 N MACARTHUR BLVD SUITE 101
IRVING TX
75038-6497
US

V. Phone/Fax

Practice location:
  • Phone: 972-255-5588
  • Fax: 972-255-6688
Mailing address:
  • Phone: 972-255-5588
  • Fax: 972-255-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS S WON
Title or Position: PHYSICIAN
Credential: MD
Phone: 972-255-5588