Provider Demographics
NPI:1144360280
Name:GREATER DALLAS ANESTHESIA & PAIN MANAGEMENT
Entity type:Organization
Organization Name:GREATER DALLAS ANESTHESIA & PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-956-0888
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-0640
Mailing Address - Country:US
Mailing Address - Phone:972-956-0888
Mailing Address - Fax:972-956-0999
Practice Address - Street 1:301 W ROUND GROVE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8106
Practice Address - Country:US
Practice Address - Phone:972-956-0888
Practice Address - Fax:972-956-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0072MQOtherBCBS
TXD24873Medicare UPIN