Healthcare Provider Details

I. General information

NPI: 1790374015
Provider Name (Legal Business Name): SPECTRUM NEUROLOGY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NW CORPORATE BLVD STE 201
BOCA RATON FL
33431-7336
US

IV. Provider business mailing address

1800 NW CORPORATE BLVD STE 201
BOCA RATON FL
33431-7336
US

V. Phone/Fax

Practice location:
  • Phone: 877-414-4480
  • Fax:
Mailing address:
  • Phone: 877-414-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY SAGE
Title or Position: BILLING MANAGER
Credential:
Phone: 954-815-2286