Healthcare Provider Details

I. General information

NPI: 1255102778
Provider Name (Legal Business Name): ORTHO FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 LINTON BLVD STE 303
DELRAY BEACH FL
33484-6537
US

IV. Provider business mailing address

PO BOX 978766
DALLAS TX
75397-8766
US

V. Phone/Fax

Practice location:
  • Phone: 561-665-7701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANE TRASK
Title or Position: OF CEO
Credential:
Phone: 813-787-1128