Provider Demographics
NPI:1326223652
Name:ABOUDIB ADVANCED PAIN CENTER
Entity Type:Organization
Organization Name:ABOUDIB ADVANCED PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABOUDIB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-741-0808
Mailing Address - Street 1:3120 W SOUTHLAKE BLVD # 140
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6783
Mailing Address - Country:US
Mailing Address - Phone:817-741-0808
Mailing Address - Fax:
Practice Address - Street 1:3120 W SOUTHLAKE BLVD # 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6783
Practice Address - Country:US
Practice Address - Phone:817-741-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center