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General NPI Number Information
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NPI Number | 1881994606
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Entity Type | Organization
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Legal Business Name | GULFSHORE PAIN & WELLNESS CENTRE
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 4700 N HABANA AVE 403
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City | TAMPA
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State | FL
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Zip | 33614-7160
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Country | US
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Telephone | 813-874-1644
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Fax | 813-874-1984
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Provider Business Mailing Address
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Address Line | 4700 N HABANA AVE 403
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City | TAMPA
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State | FL
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Zip | 33614-7160
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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 | MANAGER/ACTIVE PHYSICIAN
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Name | FRED J TURNER
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Credential | M.D.
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Telephone | 813-874-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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