Healthcare Provider Details

I. General information

NPI: 1306898952
Provider Name (Legal Business Name): FLORIDA PAIN MANAGEMENT PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 LITTLE RD
TRINITY FL
34655-1811
US

IV. Provider business mailing address

PO BOX 1907
BRANDON FL
33509-1907
US

V. Phone/Fax

Practice location:
  • Phone: 727-849-5502
  • Fax: 727-849-0926
Mailing address:
  • Phone: 813-548-1100
  • Fax: 813-548-1152

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: PETER ERNST
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-849-5502