Healthcare Provider Details

I. General information

NPI: 1699708693
Provider Name (Legal Business Name): PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 301A
ST AUGUSTINE FL
32080-3117
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S SUITE 301A
ST AUGUSTINE FL
32080-3117
US

V. Phone/Fax

Practice location:
  • Phone: 904-460-9555
  • Fax: 904-460-0090
Mailing address:
  • Phone: 904-460-9555
  • Fax: 904-460-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAUL A MONZON
Title or Position: OWNER
Credential: M D
Phone: 904-460-9555