Provider Demographics
NPI:1932481801
Name:DISABILITY & PAIN CONSULTANTS OF TEXAS PA
Entity Type:Organization
Organization Name:DISABILITY & PAIN CONSULTANTS OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:877-750-1027
Mailing Address - Street 1:11700 PRESTON RD
Mailing Address - Street 2:# 660 PMB 136
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6112
Mailing Address - Country:US
Mailing Address - Phone:877-750-1027
Mailing Address - Fax:877-750-1079
Practice Address - Street 1:2550 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-4736
Practice Address - Country:US
Practice Address - Phone:877-750-1027
Practice Address - Fax:877-750-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1581208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23392Medicare UPIN
TX00T12UMedicare PIN