Provider Demographics
NPI:1881935567
Name:PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA P A
Entity type:Organization
Organization Name:PAIN MANAGEMENT SPECIALISTS OF NORTH FLORIDA P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-460-9555
Mailing Address - Street 1:1093 A1A BEACH BLVD
Mailing Address - Street 2:PMB 390
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6733
Mailing Address - Country:US
Mailing Address - Phone:904-460-9555
Mailing Address - Fax:904-460-0090
Practice Address - Street 1:199 S US HIGHWAY 17 STE C
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-6071
Practice Address - Country:US
Practice Address - Phone:904-501-3954
Practice Address - Fax:904-501-3954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51281208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE42547Medicare UPIN
FLAI043Medicare PIN