Healthcare Provider Details

I. General information

NPI: 1710389234
Provider Name (Legal Business Name): READY PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 COUNTRY PLACE BLVD BUILDING D, SUITE 101, 102
TRINITY FL
34655-1163
US

IV. Provider business mailing address

1300 FISHING LAKE DR
ODESSA FL
33556-4005
US

V. Phone/Fax

Practice location:
  • Phone: 727-264-8803
  • Fax: 727-264-8804
Mailing address:
  • Phone: 813-600-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME91494
License Number StateFL

VIII. Authorized Official

Name: DR. DOUGLAS EUGENE BOLER
Title or Position: OWNER
Credential: M.D.
Phone: 813-600-0252