Healthcare Provider Details

I. General information

NPI: 1841735701
Provider Name (Legal Business Name): SPINE AND ORTHOPAEDIC SPECIALISTS OF CENTRAL FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 S WICKHAM RD
MELBOURNE FL
32904-1135
US

IV. Provider business mailing address

2090 PALM BEACH LAKES BLVD STE 202
WEST PALM BEACH FL
33409-6523
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-0800
  • Fax: 561-600-8705
Mailing address:
  • Phone: 561-507-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN CUTLER
Title or Position: OWNER
Credential:
Phone: 561-507-0800