Organization
INSTITUTE OF INTERVENTIONAL PAIN MANAGEMENT PA
Active
Other names
West Florida Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH H TRACY MD (PRESIDENT)
(352) 597-0907
Entity
Organization
Contact information
Practice address
11319 CORTEZ BLVD, BROOKSVILLE, FL 34613-5407
(352) 597-0907
(352) 597-2243
Mailing address
PO BOX 5719, SPRING HILL, FL 34611-5719
(352) 597-0907
(352) 597-2243
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
276400470
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07882
BLUE CROSS/BLUE SHIELD
—
05
—
377097400
—
FL
01
—
5301427
GHI
—
01
—
CA4235
RRMC
—
Enumeration date
10/10/2006
Last updated
12/29/2009
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