Healthcare Provider Details
I. General information
NPI: 1609699891
Provider Name (Legal Business Name): MEDICAL SPECIALTY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1202 E SONTERRA BLVD STE 101
SAN ANTONIO TX
78258-4238
US
IV. Provider business mailing address
811 S CENTRAL EXPY STE 103
RICHARDSON TX
75080-7439
US
V. Phone/Fax
- Phone: 210-546-1410
- Fax:
- Phone: 972-636-5727
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208VP0000X |
| Taxonomy | Pain Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
HAROON
RASHEED
Title or Position: CEO
Credential:
Phone: 972-636-5727