| NPI | 1770814337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD BRYAN STEPHENS Owner 940-627-6201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX L3143) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX L3143) |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2010-09-28 |