=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295002863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUPITER PAIN MANAGEMENT CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2011
-----------------------------------------------------
Last Update Date | 11/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2151 S ALTERNATE A1A SUITE 950
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33477-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-743-2239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 RIVER DR
-----------------------------------------------------
City | TEQUESTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33469-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NATHANIEL DROURR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-262-5137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | ME72880
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------