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General NPI Number Information
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NPI Number | 1265629265
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Entity Type | Organization
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Legal Business Name | HOUSTON TEXAS PAIN MANAGEMENT
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 845 FM 1960 RD W SUITE 106
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City | HOUSTON
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State | TX
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Zip | 77090-3942
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Country | US
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Telephone | 281-357-1370
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Fax | 281-516-7693
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Provider Business Mailing Address
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Address Line | PO BOX 25408
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City | HOUSTON
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State | TX
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Zip | 77265-5408
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Country | US
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Telephone | 281-357-1370
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Fax | 281-516-7693
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. SEAN MCRAE
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Credential |
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Telephone | 281-357-1370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | H7865
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License Number State | TX
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