Provider Demographics
NPI:1740612845
Name:MY PAIN DOCTOR
Entity Type:Organization
Organization Name:MY PAIN DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:MIRANDA-GRAJALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-960-4717
Mailing Address - Street 1:4201 BEE CAVES RD STE C213
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6458
Mailing Address - Country:US
Mailing Address - Phone:512-960-4717
Mailing Address - Fax:855-868-9882
Practice Address - Street 1:4201 BEE CAVES RD STE C213
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-960-4717
Practice Address - Fax:855-868-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ44692081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty