Provider Demographics
NPI:1942520333
Name:RIGHT PATH PAIN AND SPINE CENTER PLLC
Entity Type:Organization
Organization Name:RIGHT PATH PAIN AND SPINE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:M
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-422-0020
Mailing Address - Street 1:141 WEBB DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3951
Mailing Address - Country:US
Mailing Address - Phone:863-422-0020
Mailing Address - Fax:863-422-0021
Practice Address - Street 1:141 WEBB DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3951
Practice Address - Country:US
Practice Address - Phone:863-422-0020
Practice Address - Fax:863-422-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78730207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty