MEDICARE: FLORIDA MUSCULOSKELETAL SURGICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1033523428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MUSCULOSKELETAL SURGICAL GROUP LLC

Provider Business Mailing Address
First Line	:	721 W ROBERTSON ST
Second Line	:	SUITE 102
City	:	BRANDON
State	:	FL
Zip	:	33511-4900
Country	:	US
Telephone Number	:	813-684-3707
Fax Number	:	813-643-2457

Provider Business Practice Location Address
First Line	:	1901 HAVERFORD AVE
Second Line	:	SUITE 107
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5200
Country	:	US
Telephone Number	:	813-633-0286
Fax Number	:	813-633-9225

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. JOHN D OKUN
Credential	:	M.D.
Telephone Number	:	813-684-3707

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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