Healthcare Provider Details

I. General information

NPI: 1669713137
Provider Name (Legal Business Name): TEXAS PAIN AND SPINE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 WYOMING SPGS STE 300A
ROUND ROCK TX
78681-4312
US

IV. Provider business mailing address

PO BOX 2674
CEDAR PARK TX
78630-2674
US

V. Phone/Fax

Practice location:
  • Phone: 512-388-1190
  • Fax: 512-388-1174
Mailing address:
  • Phone: 512-388-1190
  • Fax: 512-388-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberP4191
License Number StateTX

VIII. Authorized Official

Name: DR. MUHAMMAD ALI KHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 512-388-1190