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General NPI Number Information
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NPI Number | 1366701302
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Entity Type | Organization
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Legal Business Name | PAIN CENTER P A
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 8130 ROYAL PALM BLVD SUITE 100
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5703
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Country | US
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Telephone | 954-341-3538
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Fax | 954-341-3596
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Provider Business Mailing Address
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Address Line | 8130 ROYAL PALM BLVD SUITE 100
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5703
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Country | US
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Telephone | 954-341-3538
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Fax | 954-341-3596
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Authorized Official
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Title or Position | OWNER
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Name | JOHN GOMEZ
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Credential | MD
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Telephone | 954-341-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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