Healthcare Provider Details

I. General information

NPI: 1871398016
Provider Name (Legal Business Name): MEDSPORT SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-9413
US

IV. Provider business mailing address

3836 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-9413
US

V. Phone/Fax

Practice location:
  • Phone: 954-421-2355
  • Fax:
Mailing address:
  • Phone: 954-421-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENTIU POPA
Title or Position: PARTNER
Credential: MD
Phone: 201-925-0277