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General NPI Number Information
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NPI Number | 1568021087
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Entity Type | Organization
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Legal Business Name | ALLEVIATE PAIN CENTER, PLLC
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Dates
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Enumeration Date | 06/08/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 5801 MARVIN D LOVE FWY STE 105
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City | DALLAS
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State | TX
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Zip | 75237-2388
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Country | US
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Telephone | 214-305-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 SINCLAIR AVE
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City | AUSTIN
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State | TX
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Zip | 78756-3524
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Country | US
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Telephone | 575-495-2668
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BENNETT EZEKIEL
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Credential | MD
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Telephone | 575-495-2668
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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 |
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License Number State |
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