Organization
PAIN MEDICINE PHYSICIANS OF JACKSONVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PARVEEN KHANNA MD (MEDICAL DIRECTOR)
(904) 495-7200
Entity
Organization
Contact information
Practice address
10250 NORMANDY BOULEVARD, SUITE 702, JACKSONVILLE, FL 32221
(904) 495-7200
(904) 495-7199
Mailing address
10250 NORMANDY BLVD, SUITE 703, JACKSONVILLE, FL 32221-8059
(904) 495-7200
(904) 495-7199
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME87424
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME87424
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007Z4
BLUECROSSBLUESHIELD
FL
01
—
DV2304
MEDICARE RR
FL
Enumeration date
10/07/2014
Last updated
01/27/2017
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