Healthcare Provider Details

I. General information

NPI: 1215429261
Provider Name (Legal Business Name): BOCA SPINE AND PAIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GLADES RD STE 200
BOCA RATON FL
33431-6464
US

IV. Provider business mailing address

670 GLADES RD STE 200
BOCA RATON FL
33431-6464
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-9511
  • Fax: 561-990-7426
Mailing address:
  • Phone: 561-495-9511
  • Fax: 561-990-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN JAMES BURROUGH
Title or Position: OWNER
Credential: MD
Phone: 561-495-9511