Provider Demographics
NPI:1275900763
Name:TEXOMA PAIN MANAGEMENT SPECIALIST PLLC
Entity Type:Organization
Organization Name:TEXOMA PAIN MANAGEMENT SPECIALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-837-6196
Mailing Address - Street 1:1400 BRYAN DR
Mailing Address - Street 2:STE 306
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2156
Mailing Address - Country:US
Mailing Address - Phone:972-837-6196
Mailing Address - Fax:
Practice Address - Street 1:1400 BRYAN DR
Practice Address - Street 2:STE 306
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2156
Practice Address - Country:US
Practice Address - Phone:972-837-6196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28562207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty