Provider Demographics
NPI:1487270351
Name:FORMOSO PAIN SPECIALISTS, PA
Entity type:Organization
Organization Name:FORMOSO PAIN SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-588-2393
Mailing Address - Street 1:11555 CENTRAL PKWY STE 304
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2694
Mailing Address - Country:US
Mailing Address - Phone:904-650-2963
Mailing Address - Fax:
Practice Address - Street 1:11555 CENTRAL PKWY STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2694
Practice Address - Country:US
Practice Address - Phone:904-201-3111
Practice Address - Fax:904-201-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty