Provider Demographics
NPI:1881877538
Name:GULF COAST PAIN MANAGEMENT PHYSICIANS
Entity type:Organization
Organization Name:GULF COAST PAIN MANAGEMENT PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVOISIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-789-0891
Mailing Address - Street 1:3890 TAMPA RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3676
Mailing Address - Country:US
Mailing Address - Phone:727-789-0891
Mailing Address - Fax:727-789-1570
Practice Address - Street 1:3890 TAMPA RD
Practice Address - Street 2:SUITE 308
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3676
Practice Address - Country:US
Practice Address - Phone:727-789-0891
Practice Address - Fax:727-789-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99061OtherBCBS