Organization
INTERVENTIONAL & INTEGRATIVE PAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY PANTON MD (OWNER)
(813) 496-1075
Entity
Organization
Contact information
Practice address
8513 S US HIGHWAY 1, STE 4, PORT ST LUCIE, FL 34952-3346
(813) 496-1075
Mailing address
8513 S US HIGHWAY 1, STE 4, PORT ST LUCIE, FL 34952-3346
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME62002
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
ME62002
FL
208VP0000X
Pain Medicine Physician
Primary
ME62002
FL
208VP0014X
Interventional Pain Medicine Physician
ME62002
FL
Other
Enumeration date
07/18/2010
Last updated
01/27/2012
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