Healthcare Provider Details

I. General information

NPI: 1487743563
Provider Name (Legal Business Name): SPINE AND ORTHOPAEDIC SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 SHORT AVE
ODESSA FL
33556-3427
US

IV. Provider business mailing address

2040 SHORT AVE
ODESSA FL
33556-3427
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-9922
  • Fax: 727-372-8477
Mailing address:
  • Phone: 727-372-9922
  • Fax: 727-372-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME96330
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME96135
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME96135
License Number StateFL

VIII. Authorized Official

Name: FARHAN NAVEED SIDDIQI
Title or Position: PARTNER
Credential: MD
Phone: 727-372-9922