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General NPI Number Information
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NPI Number | 1427156140
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Entity Type | Organization
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Legal Business Name | PAIN CLINIC OF NORTHWEST FL INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 2250 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4548
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Country | US
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Telephone | 850-784-2477
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Fax | 850-784-6848
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Provider Business Mailing Address
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Address Line | 2250 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4548
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Country | US
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Telephone | 850-784-2477
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Fax | 850-784-6848
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROBERT JAY JOSEPH
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Credential | M.D.
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Telephone | 850-784-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PMC 150
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License Number State | FL
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