MEDICARE: BLUE WATER PAIN SOLUTIONS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316352545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE WATER PAIN SOLUTIONS, PA

Provider Business Mailing Address
First Line	:	2010 NW 150TH AVE STE 100
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2888
Country	:	US
Telephone Number	:	954-447-5206
Fax Number	:	954-447-5259

Provider Business Practice Location Address
First Line	:	2010 NW 150TH AVE STE 100
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2888
Country	:	US
Telephone Number	:	954-447-5206
Fax Number	:	954-447-5259

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LOWELL S. DAVIS
Credential	:	D.O.
Telephone Number	:	954-447-5206

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	12/03/2025

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Directions to “BLUE WATER PAIN SOLUTIONS, PA ” Practice Location

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