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General NPI Number Information
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NPI Number | 1962589671
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Entity Type | Organization
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Legal Business Name | PREMIER PAIN SPECIALISTS LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 1228 SE 8TH TER
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City | CAPE CORAL
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State | FL
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Zip | 33990-3210
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Country | US
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Telephone | 239-945-1105
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Fax | 239-945-4495
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Provider Business Mailing Address
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Address Line | 1228 SE 8TH TER
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City | CAPE CORAL
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State | FL
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Zip | 33990-3210
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Country | US
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Telephone | 239-945-1105
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Fax | 239-945-4495
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULES ALVA PREUDHOMME
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Credential | M.D
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Telephone | 239-945-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME72077
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License Number State | FL
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