Healthcare Provider Details

I. General information

NPI: 1922037290
Provider Name (Legal Business Name): PAIN MANAGEMENT PHYSICIANS OF SOUTH FLORIDA, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 ROYAL PALM BLVD SUITE 103
CORAL SPRINGS FL
33065-5727
US

IV. Provider business mailing address

6295 NW 96TH TER
PARKLAND FL
33076-1815
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-8233
  • Fax: 954-974-2335
Mailing address:
  • Phone: 954-605-3724
  • Fax: 954-255-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME 66192
License Number StateFL

VIII. Authorized Official

Name: ANDREW JAY GOLDBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-605-3724