Healthcare Provider Details

I. General information

NPI: 1093158230
Provider Name (Legal Business Name): DRUG FREE PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 CHIMNEY CORNER LN 1026
JUPITER FL
33458-4800
US

IV. Provider business mailing address

3154 SAN MICHELE DR
PALM BEACH GARDENS FL
33418-6702
US

V. Phone/Fax

Practice location:
  • Phone: 561-444-9805
  • Fax:
Mailing address:
  • Phone: 561-444-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME84984
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN GARDNER JR.
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 561-444-9805