Healthcare Provider Details

I. General information

NPI: 1558895730
Provider Name (Legal Business Name): SOUTHERN LASER SPINE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 SE 1ST AVE
FORT LAUDERDALE FL
33316-1802
US

IV. Provider business mailing address

1216 SE 1ST AVE
FORT LAUDERDALE FL
33316-1802
US

V. Phone/Fax

Practice location:
  • Phone: 954-255-8406
  • Fax:
Mailing address:
  • Phone: 954-255-8406
  • Fax:

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: DR. LAWRENCE ALEXANDER
Title or Position: PRESIDENT
Credential: MD
Phone: 954-255-8406