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General NPI Number Information
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NPI Number | 1619386729
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Entity Type | Organization
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Legal Business Name | COLVIN PAIN MANAGEMENT PLLC
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 4642 N LOOP 289 STE 209
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City | LUBBOCK
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State | TX
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Zip | 79416-2425
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Country | US
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Telephone | 806-797-4596
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Fax | 855-529-0586
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Provider Business Mailing Address
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Address Line | 4642 N LOOP 289 STE 209
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City | LUBBOCK
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State | TX
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Zip | 79416-2425
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Country | US
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Telephone | 806-797-4596
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Fax | 855-529-0586
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Authorized Official
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Title or Position | PHYSICAN
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Name | DR. JEFFERY N COLVIN
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Credential | M.D.
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Telephone | 806-797-4596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H2313
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License Number State | TX
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