=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699708693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 09/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 PLANTATION ISLAND DR S STE 301A
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-3117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-460-9555
-----------------------------------------------------
Fax | 904-460-0090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 PLANTATION ISLAND DR S SUITE 301A
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-3117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-460-9555
-----------------------------------------------------
Fax | 904-460-0090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RAUL A MONZON
-----------------------------------------------------
Credential | M D
-----------------------------------------------------
Telephone | 904-460-9555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------