Healthcare Provider Details

I. General information

NPI: 1669069050
Provider Name (Legal Business Name): ORTHO FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 WEST CAMINO REAL STE 104
BOCA RATON FL
33433-5511
US

IV. Provider business mailing address

751 PARK OF COMMERCE DR STE 112
BOCA RATON FL
33487-3622
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-9511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA WEICHT
Title or Position: COO
Credential:
Phone: 561-300-1792