Basic Information
| Provider Information | |||||||||
| NPI: | 1366975278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN & ANESTHESIA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 CONWAY ISLE CIR | ||||||||
| Address2: | |||||||||
| City: | BELLE ISLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328093301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086539399 | ||||||||
| FaxNumber: | 9086539305 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 MOUNT HOMER RD | ||||||||
| Address2: | |||||||||
| City: | EUSTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327266258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086539399 | ||||||||
| FaxNumber: | 9086539305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | STERLING | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9086539399 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.