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General NPI Number Information
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NPI Number | 1952722670
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT CONSULTANTS IN COASTAL BEND PLLC
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 12/23/2013
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Provider Practice Location Address
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Address Line | 1711 W WHEELER AVE
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City | ARANSAS PASS
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State | TX
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Zip | 78336-4536
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Country | US
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Telephone | 214-952-3018
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Fax |
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Provider Business Mailing Address
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Address Line | 3757 FM 1781
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City | ROCKPORT
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State | TX
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Zip | 78382-7613
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Country | US
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Telephone | 214-952-3018
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK YELDERMAN
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Credential | M.D.
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Telephone | 214-952-3018
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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 | E1973
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License Number State | TX
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