Organization
DYNAMIC SPORTS MEDICINE AND PAIN SOLUTIONS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICAL SAMUELSON DUVALL MD (PRESIDENT)
(210) 602-5578
Entity
Organization
Contact information
Practice address
7830 W GRAND PKWY S, SUITE 150, RICHMOND, TX 77406-5816
(832) 302-6212
Mailing address
41922 N MILL DR, MAGNOLIA, TX 77354-1850
(210) 602-5578
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
Q0169
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669600324
NPI
TX
Enumeration date
03/08/2016
Last updated
03/08/2016
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