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General NPI Number Information
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NPI Number | 1710618160
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Entity Type | Organization
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Legal Business Name | SOUTHEAST INTERVENTIONAL PAIN SPECIALISTS, INC
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 12276 SAN JOSE BLVD STE 210
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8631
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Country | US
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Telephone | 904-717-9625
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Fax | 904-683-6499
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Provider Business Mailing Address
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Address Line | 12276 SAN JOSE BLVD STE 210
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABRAHAM FURA
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Credential | DO
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Telephone | 904-902-4126
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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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