Dallas Interventional Pain PLLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

Q9070 Issued in TX

Legal business name

DALLAS INTERVENTIONAL PAIN PLLC

Practice address

5316 W Plano Pkwy
Plano, TX 75093-4821

Phone

(972) 349-1333

NPI assigned

Nov 4, 2016

Last updated

Feb 7, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shawna Boudreaux

Title

VP Operations

Phone

(469) 422-0641

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549497600000",
    "number": "1952853152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15110 DALLAS PKWY STE 102",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752484601",
            "telephone_number": "972-349-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5316 W PLANO PKWY",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750934821",
            "telephone_number": "972-349-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS INTERVENTIONAL PAIN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2019-02-07",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "469-422-0641"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "TX",
            "license": "Q9070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Interventional Pain Medicine Physician in Plano, TX
• Providers in Plano, TX by specialty
• Interventional Pain Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.