Healthcare Provider Details

I. General information

NPI: 1215111596
Provider Name (Legal Business Name): BCMD PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2007
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6056 BOYNTON BEACH BLVD STE 115
BOYNTON BEACH FL
33437-3500
US

IV. Provider business mailing address

6586 HYPOLUXO RD SUITE #334
LAKE WORTH FL
33467-7678
US

V. Phone/Fax

Practice location:
  • Phone: 877-412-7272
  • Fax: 561-967-0954
Mailing address:
  • Phone: 877-412-7272
  • Fax: 561-967-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberME86864
License Number StateFL

VIII. Authorized Official

Name: DR. BLAINE SIMON CAMERON
Title or Position: OWNER
Credential: M.D.
Phone: 877-412-7272