Healthcare Provider Details

I. General information

NPI: 1134405467
Provider Name (Legal Business Name): BOCA PAIN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 MEADOWS RD SUITE 212
BOCA RATON FL
33486-2348
US

IV. Provider business mailing address

851 MEADOWS ROAD SUITE 212
BOCA RATON FL
33486
US

V. Phone/Fax

Practice location:
  • Phone: 561-392-1333
  • Fax: 561-392-9707
Mailing address:
  • Phone: 561-392-1333
  • Fax: 561-392-9707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6527
License Number StateFL

VIII. Authorized Official

Name: DR. BRUCE MICHAEL FISCHER
Title or Position: MANAGER
Credential: DC
Phone: 561-392-1333