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General NPI Number Information
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NPI Number | 1184106197
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Entity Type | Organization
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Legal Business Name | ASHOKA PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 804 HIGHWAY 466
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City | LADY LAKE
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State | FL
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Zip | 32159-3918
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Country | US
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Telephone | 352-267-9170
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Fax |
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Provider Business Mailing Address
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Address Line | 804 HIGHWAY 466
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City | LADY LAKE
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State | FL
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Zip | 32159-3918
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Country | US
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Telephone | 352-267-9170
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Fax |
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Authorized Official
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Title or Position | DOC
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Name | ROGER SPENCER
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Credential | MD
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Telephone | 352-267-9170
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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 | ME60172
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License Number State | FL
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