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General NPI Number Information
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NPI Number | 1932173283
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Entity Type | Organization
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Legal Business Name | JONATHAN T PAINE MD PA
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 1305 VALENTINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3127
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Country | US
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Telephone | 321-727-2468
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Fax | 321-952-0163
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Provider Business Mailing Address
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Address Line | 1305 VALENTINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3127
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Country | US
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Telephone | 321-727-2468
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Fax | 321-952-0163
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN T. PAINE
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Credential | M.D.
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Telephone | 321-727-2468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME0050830
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License Number State | FL
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