| NPI | 1043523152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY PANTON Owner 813-496-1075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME62002) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME62002) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: FL ME62002) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME62002) | |
| Enumeration Date | 2010-07-18 |
| Last Update Date | 2012-01-27 |