Provider Demographics
NPI:1881821783
Name:BRANDON PAIN MEDICINE, INC.
Entity Type:Organization
Organization Name:BRANDON PAIN MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:MIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-571-7117
Mailing Address - Street 1:514 EICHEFELD DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-571-7117
Mailing Address - Fax:813-571-7017
Practice Address - Street 1:514 EICHEFELD DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-571-7117
Practice Address - Fax:813-571-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44537207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD62206Medicare UPIN