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General NPI Number Information
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NPI Number | 1548105372
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Entity Type | Organization
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Legal Business Name | FORMOSO PAIN SPECIALISTS, PA
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 857 EDGEWOOD AVE S
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City | JACKSONVILLE
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State | FL
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Zip | 32205-5362
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Country | US
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Telephone | 904-201-3111
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Fax | 904-201-3095
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Provider Business Mailing Address
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Address Line | 857 EDGEWOOD AVE S
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City | JACKSONVILLE
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State | FL
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Zip | 32205-5362
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Country | US
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Telephone | 904-201-3111
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Fax | 904-201-3095
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Authorized Official
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Title or Position | OWNER/CEO
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Name | FERDINAND JOSEPH FORMOSO
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Credential | DO
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Telephone | 904-201-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) 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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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