Provider Demographics
NPI:1154989937
Name:DYNAMIC PAIN MANAGEMENT, PLLC
Entity type:Organization
Organization Name:DYNAMIC PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-462-1696
Mailing Address - Street 1:5605 NEWCASTLE ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 MCPHERSON RD STE 111
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6403
Practice Address - Country:US
Practice Address - Phone:956-462-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain