Healthcare Provider Details

I. General information

NPI: 1073865572
Provider Name (Legal Business Name): WHITE MOUNTAIN PAIN ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 S WHITE MOUNTAIN RD
SHOW LOW AZ
85901-7306
US

IV. Provider business mailing address

PO BOX 72090
PHOENIX AZ
85050-1019
US

V. Phone/Fax

Practice location:
  • Phone: 928-532-7559
  • Fax: 928-532-8599
Mailing address:
  • Phone: 480-361-7680
  • Fax: 480-361-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. ROBERT J BROWNSBERGER
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 480-361-7680