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General NPI Number Information
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NPI Number | 1548923246
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Entity Type | Organization
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Legal Business Name | SPINEPAINBEGONE PA
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 2833 BABCOCK RD STE 306
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4896
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Country | US
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Telephone | 210-705-5470
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Fax | 210-615-8605
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Provider Business Mailing Address
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Address Line | 2833 BABCOCK RD STE 306
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4896
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Country | US
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Telephone | 210-705-5470
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Fax | 210-615-8605
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. GUY RUTLEDGE FOGEL
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Credential | M.D.
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Telephone | 210-057-5470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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