Organization
VALOR INTERVENTIONAL PAIN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY J KENESON II DO (OWNER)
(682) 936-2544
Entity
Organization
Contact information
Practice address
6620 BRYANT IRVIN RD STE 100, FORT WORTH, TX 76132-4224
(682) 936-2544
Mailing address
806 OLD CLEBURNE RD, GRANBURY, TX 76048-1422
(682) 936-2544
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528369592
NPI INDIVIDUAL
TX
Enumeration date
06/02/2020
Last updated
10/22/2020
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