Provider Demographics
NPI:1194817825
Name:SPINE SPECIALISTS, PA
Entity Type:Organization
Organization Name:SPINE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PAUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-593-2222
Mailing Address - Street 1:PO BOX 9984
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711
Mailing Address - Country:US
Mailing Address - Phone:903-593-2222
Mailing Address - Fax:903-593-0142
Practice Address - Street 1:1814 ROSELAND BLVD.
Practice Address - Street 2:SUITE 250
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-593-2222
Practice Address - Fax:903-593-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty