Provider Demographics
NPI:1720009046
Name:PHYSIATRY PAIN MANAGEMENT, P.A
Entity Type:Organization
Organization Name:PHYSIATRY PAIN MANAGEMENT, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZONDLO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD,FIPP
Authorized Official - Phone:850-862-2912
Mailing Address - Street 1:999 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6758
Mailing Address - Country:US
Mailing Address - Phone:850-862-2912
Mailing Address - Fax:850-862-2951
Practice Address - Street 1:999 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6758
Practice Address - Country:US
Practice Address - Phone:850-862-2912
Practice Address - Fax:850-862-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41610AMedicare ID - Type Unspecified
FLC75719Medicare UPIN