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General NPI Number Information
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NPI Number | 1114113669
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN MANAGEMENT, PA
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3312 N UNIVERSITY DR SUITE J
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2637
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Country | US
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Telephone | 936-560-2222
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Fax | 936-569-1788
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Provider Business Mailing Address
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Address Line | 3312 N UNIVERSITY DR SUITE J
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2637
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Country | US
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Telephone | 936-560-2222
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Fax | 936-569-1788
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Authorized Official
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Title or Position | MD/OWNER
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Name | JAMES D DAVIS
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Credential | MD
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Telephone | 936-560-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | J8185
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License Number State | TX
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