Healthcare Provider Details

I. General information

NPI: 1679699557
Provider Name (Legal Business Name): SOUTH FLORIDA SPINE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BAYVIEW DRIVE
FT LAUDERDALE FL
33306
US

IV. Provider business mailing address

3000 BAYVIEW DRIVE
FT LAUDERDALE FL
33306
US

V. Phone/Fax

Practice location:
  • Phone: 954-567-1332
  • Fax: 954-537-7705
Mailing address:
  • Phone: 954-567-1332
  • Fax: 954-537-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY B. CANTOR
Title or Position: OWNER
Credential: M.D.
Phone: 954-567-1332