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Organization

PENINSULA PAIN MANAGEMENT, LLC

Active
Other names
Fox Laser, LLC
Organization subpart
No

Provider details

NPI number
Authorized official
BRENT FOX (OWNER)
(443) 783-3543
Entity
Organization

Contact information

Practice address
13014 RIGGIN RIDGE RD, OCEAN CITY, MD 21842-9716
(443) 783-3543
Mailing address
13014 RIGGIN RIDGE RD, OCEAN CITY, MD 21842-9716
(443) 783-3543

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
208VP0000X
Pain Medicine Physician
D0035246
MD
208VP0014X
Interventional Pain Medicine Physician
Primary
D0035246
MD
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Enumeration date
06/08/2009
Last updated
12/08/2012
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