Basic Information
| Provider Information | |||||||||
| NPI: | 1235227026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN INSTITUTE OF TAMPA BAY PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15303 AMBERLY DR STE A | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336472308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139776688 | ||||||||
| FaxNumber: | 8139776798 | ||||||||
| Practice Location | |||||||||
| Address1: | 15303 AMBERLY DR STE A | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336472308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139776688 | ||||||||
| FaxNumber: | 8139776798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 08/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | RAMIREZ-PAGAN | ||||||||
| AuthorizedOfficialFirstName: | EDGAR | ||||||||
| AuthorizedOfficialMiddleName: | DANIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8139776688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | OS8446 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.