Provider Demographics
NPI:1518426691
Name:NORTH DALLAS PAIN MANAGEMENT CENTER, P.A.
Entity Type:Organization
Organization Name:NORTH DALLAS PAIN MANAGEMENT CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:JAVED
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-316-3344
Mailing Address - Street 1:6505 W PARK BLVD
Mailing Address - Street 2:STE 306 PMB 376
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6212
Mailing Address - Country:US
Mailing Address - Phone:972-316-3344
Mailing Address - Fax:972-316-3322
Practice Address - Street 1:825 W ROYAL LN STE 230
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3901
Practice Address - Country:US
Practice Address - Phone:972-956-5541
Practice Address - Fax:469-730-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty