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General NPI Number Information
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NPI Number | 1598242539
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Entity Type | Organization
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Legal Business Name | PANHANDLE PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 5330 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32503-2006
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Country | US
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Telephone | 850-477-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 398 CAMINO GARDENS BLVD STE 102
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City | BOCA RATON
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State | FL
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Zip | 33432-5827
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Country | US
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Telephone | 561-392-3341
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP RENFROE
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Credential |
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Telephone | 850-477-5610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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