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General NPI Number Information
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NPI Number | 1407962137
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Entity Type | Organization
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Legal Business Name | PAIN MEDICINE ASSOCIATES P.A.
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 3945 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34233-2364
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Country | US
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Telephone | 941-926-4770
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Fax | 941-923-2520
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Provider Business Mailing Address
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Address Line | 3945 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34233-2364
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Country | US
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Telephone | 941-926-4770
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Fax | 941-923-2520
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Authorized Official
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Title or Position | OWNER
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Name | LYNN R FASSY
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Credential | M.D.
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Telephone | 941-926-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | ME64532
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License Number State | FL
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