Healthcare Provider Details

I. General information

NPI: 1932548617
Provider Name (Legal Business Name): WHITING NEUROSURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 S INTERNATIONAL PKWY SUITE 1111
LAKE MARY FL
32746-1407
US

IV. Provider business mailing address

1315 S INTERNATIONAL PKWY SUITE 1111
LAKE MARY FL
32746-1407
US

V. Phone/Fax

Practice location:
  • Phone: 407-903-9360
  • Fax: 407-423-9505
Mailing address:
  • Phone: 407-903-9360
  • Fax: 407-423-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME102824
License Number StateFL

VIII. Authorized Official

Name: MRS. DEBBIE MACLAUGHLIN
Title or Position: MANAGER
Credential:
Phone: 407-903-9360