MEDICARE: PAN AMERICAN PAIN INSTITUTE PL

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	208VP0014X	Interventional Pain Medicine Physician	ME79046	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD7254	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1023195658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAN AMERICAN PAIN INSTITUTE PL

Provider Business Mailing Address
First Line	:	PO BOX 20286
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-0286
Country	:	US
Telephone Number	:	727-823-2188
Fax Number	:	727-823-9502

Provider Business Practice Location Address
First Line	:	16542 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1325
Country	:	US
Telephone Number	:	813-908-7868
Fax Number	:

Authorized Official
Title or Position	:	OWNER PROVIDER
Name	:	DARIO AQUILES GRISALES
Credential	:	MD
Telephone Number	:	813-908-7868

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/11/2010

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Directions to “PAN AMERICAN PAIN INSTITUTE PL ” Practice Location

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