MEDICARE: NORTH DALLAS PAIN MANAGEMENT CENTER, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1518426691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH DALLAS PAIN MANAGEMENT CENTER, P.A.

Provider Business Mailing Address
First Line	:	6505 W PARK BLVD
Second Line	:	STE 306 PMB 376
City	:	PLANO
State	:	TX
Zip	:	75093-6212
Country	:	US
Telephone Number	:	972-316-3344
Fax Number	:	972-316-3322

Provider Business Practice Location Address
First Line	:	825 W ROYAL LN STE 230
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3901
Country	:	US
Telephone Number	:	972-956-5541
Fax Number	:	469-730-2192

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMMAD JAVED TARIQ
Credential	:
Telephone Number	:	972-316-3344

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	03/18/2019

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