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General NPI Number Information
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NPI Number | 1043606387
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Entity Type | Organization
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Legal Business Name | PREMIER PAIN MANAGEMENT, PLLC
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 3255 NW 94TH AVE SUITE 9161
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City | CORAL SPRINGS
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State | FL
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Zip | 33075-2001
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Country | US
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Telephone | 973-698-7768
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9161
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City | CORAL SPRINGS
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State | FL
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Zip | 33075-9161
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Country | US
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Telephone | 973-698-7768
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | JANICE DEBRA VICTOR
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Credential | M.D.
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Telephone | 973-698-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME100973
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License Number State | FL
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