Provider Demographics
NPI:1134577703
Name:PEGASUS PAIN MANAGEMENT
Entity type:Organization
Organization Name:PEGASUS PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIDOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-702-5855
Mailing Address - Street 1:8604 GREENVILLE AVE
Mailing Address - Street 2:STE 103A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7148
Mailing Address - Country:US
Mailing Address - Phone:214-702-5855
Mailing Address - Fax:877-244-9193
Practice Address - Street 1:8604 GREENVILLE AVE
Practice Address - Street 2:STE 103A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7148
Practice Address - Country:US
Practice Address - Phone:214-702-5855
Practice Address - Fax:877-244-9193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAARLMED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-24
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty