Healthcare Provider Details

I. General information

NPI: 1306083332
Provider Name (Legal Business Name): ORTHOPAEDIC AND SPINAL ASSOCIATES OF SOUTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD SUITE 830
MIAMI BEACH FL
33140-2840
US

IV. Provider business mailing address

4308 ALTON RD SUITE 830
MIAMI BEACH FL
33140-2840
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-2411
  • Fax:
Mailing address:
  • Phone: 305-532-2411
  • 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: MR. JERRY C WINDLE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 305-532-2411