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General NPI Number Information
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NPI Number | 1679908867
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Entity Type | Organization
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Legal Business Name | NEW SMYRNA PAIN & INJURY CLINIC
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 421 N CAUSEWAY
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5266
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Country | US
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Telephone | 386-900-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 421 N CAUSEWAY
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5266
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Country | US
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Telephone | 386-900-7246
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | HAROLD LAWLER
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Credential |
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Telephone | 386-690-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | ME59641
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License Number State | FL
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