Healthcare Provider Details

I. General information

NPI: 1700970126
Provider Name (Legal Business Name): SPINE INSTITUTE OF SOUTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 LINTON BLVD SUITE 103
DELRAY BEACH FL
33484-6542
US

IV. Provider business mailing address

5210 LINTON BLVD SUITE 103
DELRAY BEACH FL
33484-6542
US

V. Phone/Fax

Practice location:
  • Phone: 561-381-4271
  • Fax: 561-381-4273
Mailing address:
  • Phone: 561-381-4271
  • Fax: 561-381-4273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN G DAVIS
Title or Position: MANAGER
Credential:
Phone: 561-381-4271