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General NPI Number Information
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NPI Number | 1194817825
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Entity Type | Organization
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Legal Business Name | SPINE SPECIALISTS, PA
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 1814 ROSELAND BLVD. SUITE 250
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City | TYLER
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State | TX
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Zip | 75701
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Country | US
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Telephone | 903-593-2222
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Fax | 903-593-0142
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Provider Business Mailing Address
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Address Line | PO BOX 9984
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City | TYLER
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State | TX
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Zip | 75711
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Country | US
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Telephone | 903-593-2222
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Fax | 903-593-0142
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | KEVIN JOSEPH PAUZA
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Credential | M.D.
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Telephone | 903-593-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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