Healthcare Provider Details

I. General information

NPI: 1225060338
Provider Name (Legal Business Name): INTERVENTIONAL SPINE INSTITUTE OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S HARBOR CITY BLVD SUITE A
MELBOURNE FL
32901-1500
US

IV. Provider business mailing address

308 S HARBOR CITY BLVD SUITE A
MELBOURNE FL
32901-1500
US

V. Phone/Fax

Practice location:
  • Phone: 321-733-0064
  • Fax: 321-733-7970
Mailing address:
  • Phone: 321-733-0064
  • Fax: 321-733-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME109841
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME0076009
License Number StateFL

VIII. Authorized Official

Name: BRIAN CHRISTOPHER DOWDELL
Title or Position: CEO/MED DIRECTOR
Credential: MD
Phone: 321-733-0064