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General NPI Number Information
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NPI Number | 1457306441
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT OF BREVARD PLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 450 E MERRITT ISLAND CSWY STE 200
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3503
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Country | US
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Telephone | 321-735-6220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 948075
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City | MAITLAND
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State | FL
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Zip | 32794-8075
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Country | US
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Telephone | 321-735-6220
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF PMB
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Name | JOSEPH BLOOM
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Credential | MD
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Telephone | 321-735-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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