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General NPI Number Information
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NPI Number | 1649707548
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEADACHE AND PAIN MANAGEMENT
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 05/23/2017
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Provider Practice Location Address
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Address Line | 401 W FAIRMONT PKWY STE D
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City | LA PORTE
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State | TX
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Zip | 77571-6314
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Country | US
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Telephone | 832-858-6531
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 NASA PKWY 220Q
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City | HOUSTON
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State | TX
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Zip | 77058-3342
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Country | US
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Telephone |
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Fax | 832-240-3370
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMAD AZZAM
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Credential |
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Telephone | 832-858-6531
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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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Taxonomy #2
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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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