Healthcare Provider Details

I. General information

NPI: 1396172789
Provider Name (Legal Business Name): DIGITAL RADIOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 BAY TER
NORTH BAY VILLAGE FL
33141-4002
US

IV. Provider business mailing address

1353 BAY TER
NORTH BAY VILLAGE FL
33141-4002
US

V. Phone/Fax

Practice location:
  • Phone: 305-759-9293
  • Fax: 305-759-5544
Mailing address:
  • Phone: 305-759-9293
  • Fax: 305-759-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberME83541
License Number StateFL

VIII. Authorized Official

Name: DR. DOUGLAS NEAL HORNSBY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-759-9293