Provider Demographics
NPI:1679964449
Name:AFA PAIN SPECIALISTS, INC
Entity Type:Organization
Organization Name:AFA PAIN SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-654-3918
Mailing Address - Street 1:PO BOX 65748
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-0013
Mailing Address - Country:US
Mailing Address - Phone:904-639-6747
Mailing Address - Fax:904-639-6769
Practice Address - Street 1:728 BLANDING BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7728
Practice Address - Country:US
Practice Address - Phone:904-639-6747
Practice Address - Fax:904-639-6769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113190207LP2900X, 208VP0014X, 208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIC755AMedicare PIN