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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