Healthcare Provider Details

I. General information

NPI: 1053093484
Provider Name (Legal Business Name): VALIANT ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 W AIRPORT FWY STE 205
IRVING TX
75062-5840
US

IV. Provider business mailing address

4441 W AIRPORT FWY STE 205
IRVING TX
75062-5840
US

V. Phone/Fax

Practice location:
  • Phone: 469-444-7246
  • Fax:
Mailing address:
  • Phone: 469-444-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: AUDREY GIVEN
Title or Position: OWNER
Credential:
Phone: 469-444-7246