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General NPI Number Information
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NPI Number | 1942252531
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Entity Type | Organization
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Legal Business Name | MARTIN COUNTY PAIN CLINIC PL
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 725 SE OSCEOLA ST SUITE 2
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City | STUART
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State | FL
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Zip | 34994-2318
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Country | US
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Telephone | 772-286-0078
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Fax | 866-665-2702
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Provider Business Mailing Address
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Address Line | 725 SE OSCEOLA ST STE 2
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City | STUART
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State | FL
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Zip | 34994-2318
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Country | US
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Telephone | 772-286-0078
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Fax | 772-286-2288
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALBERT E GARDNER
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Credential | MD
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Telephone | 772-286-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | ME15899
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License Number State | FL
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