Organization
PAIN CLINIC OF NORTHWEST FL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J JOSEPH M.D. (PRESIDENT)
(850) 784-2477
Entity
Organization
Contact information
Practice address
4284 KELSON AVE, MARIANNA, FL 32446
(850) 784-2477
(850) 784-6848
Mailing address
2250 HARRISON AVE, PANAMA CITY, FL 32405
(850) 784-2477
(850) 784-6848
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2680076 01
—
FL
01
—
3857260001
DMERC PTAN
FL
01
—
CM7126
RRB PTAN
FL
Enumeration date
05/15/2007
Last updated
01/03/2012
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