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NPI Code Detail

MEDICARE: TD PAIN SERVICES PLLC

MEDICARE: TD PAIN SERVICES PLLC
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
1208VP0000XPain Medicine Physician

General Provider Information

NPI Number : 1639736903
Entity Type Code : Organization
Provider Name (Legal Business Name) : TD PAIN SERVICES PLLC
Provider Business Mailing Address
First Line : 3728 SHADY HILL DR
Second Line :
City : DALLAS
State : TX
Zip : 75229-2711
Country : US
Telephone Number : 918-549-8284
Fax Number : 877-576-0804
Provider Business Practice Location Address
First Line : 3728 SHADY HILL DR
Second Line :
City : DALLAS
State : TX
Zip : 75229-2711
Country : US
Telephone Number : 918-549-8284
Fax Number : 877-576-0804
Authorized Official
Title or Position : OWNER
Name : DR. TERAN M DAVIS
Credential : MD
Telephone Number : 918-549-8284
Provider Enumeration Date : 05/22/2019
Last Update Date : 05/22/2019

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Directions to “TD PAIN SERVICES PLLC ” Practice Location

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