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General NPI Number Information
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NPI Number | 1316079734
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Entity Type | Organization
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Legal Business Name | ESA
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 508 WOODSTREAM PL
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City | MESQUITE
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State | TX
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Zip | 75149-5874
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Country | US
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Telephone | 254-694-5092
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Fax | 254-694-7039
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Provider Business Mailing Address
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Address Line | PO BOX 1108
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City | LANCASTER
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State | TX
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Zip | 75146-8108
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Country | US
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Telephone | 254-694-5092
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Fax | 254-694-7039
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Authorized Official
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Title or Position | OWNER
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Name | BRADLEY EAMES
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Credential | D.O.
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Telephone | 254-694-5092
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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 |
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License Number State |
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