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General NPI Number Information
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NPI Number | 1922617125
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT SPECIALISTS
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 2425 BABCOCK RD STE 111
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4899
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Country | US
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Telephone | 210-358-3108
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Fax | 210-702-4750
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Provider Business Mailing Address
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Address Line | PO BOX 734812
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City | DALLAS
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State | TX
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Zip | 75373-4812
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Country | US
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Telephone | 210-358-9500
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Fax | 210-358-9183
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Authorized Official
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Title or Position | MEMBER
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Name | DR. AKINTOMI A. OLUGBODI
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Credential | MD
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Telephone | 610-568-5078
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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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