MEDICARE: GLOBAL PAIN MANAGEMENT, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	PMC 1254	FL

General Provider Information

NPI Number	:	1013209337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL PAIN MANAGEMENT, PA

Provider Business Mailing Address
First Line	:	949 NE 125TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	949 NE 125TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5741
Country	:	US
Telephone Number	:	786-360-4043
Fax Number	:	786-362-6328

Authorized Official
Title or Position	:	OWNER
Name	:	JAIME GABRIEL GUTIERREZ
Credential	:	MD
Telephone Number	:	305-763-0880

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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