Organization
PENINSULA PAIN CLINIC, PLLC
Active
Parent organization
PENINSULA PAIN CLINIC, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENINSULA PAIN CLINIC, PLLC
Authorized official
TERRY PEXTON DO (MEDICAL DIRECTOR)
(360) 415-9110
Entity
Organization
Contact information
Practice address
2601 CHERRY AVE STE 200, BREMERTON, WA 98310-4208
(360) 415-9110
(360) 479-0265
Mailing address
2980 N BEVERLY GLEN CIR STE 100, LOS ANGELES, CA 90077-1728
(310) 943-4180
(888) 431-8819
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QP3300X
Pain Clinic/Center
Primary
—
—
332900000X
Non-Pharmacy Dispensing Site
OP60339103
WA
Other
Enumeration date
09/18/2015
Last updated
07/22/2019
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