Provider Demographics
NPI:1245764554
Name:REGENERATIVE MEDICINE AND PAIN MANAGEMENT PHYSICIANS PLLC
Entity Type:Organization
Organization Name:REGENERATIVE MEDICINE AND PAIN MANAGEMENT PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-462-4544
Mailing Address - Street 1:PO BOX 30332
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1332
Mailing Address - Country:US
Mailing Address - Phone:850-462-4544
Mailing Address - Fax:850-777-3166
Practice Address - Street 1:3406 SANTA ROSA DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-5665
Practice Address - Country:US
Practice Address - Phone:850-462-4544
Practice Address - Fax:850-777-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42993208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty