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Organization
PALM TREE INTERVENTIONAL PAIN MANAGEMENT, PLLC
Active
Organization
PALM TREE INTERVENTIONAL PAIN MANAGEMENT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON JEONG HWAN SONG MD (MEDICAL DIRECTOR)
(267) 312-9857
Entity
Organization
Contact information
Practice address
2801 17TH ST UNIT 202, SAINT CLOUD, FL 34769-4939
(407) 906-1328
(866) 425-8143
Mailing address
2801 17TH ST UNIT 202, SAINT CLOUD, FL 34769-4939
(407) 906-1328
(866) 425-8143
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
FL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020119900
—
FL
Enumeration date
12/03/2016
Last updated
10/01/2020
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