Healthcare Provider Details

I. General information

NPI: 1073058855
Provider Name (Legal Business Name): ORTHO FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 LINTON BLVD STE 203
DELRAY BEACH FL
33484-6567
US

IV. Provider business mailing address

751 PARK OF COMMERCE DR STE 112
BOCA RATON FL
33487-3626
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 Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

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