Healthcare Provider Details

I. General information

NPI: 1245217744
Provider Name (Legal Business Name): SPINE & BRAIN NEUROSURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7460 DOCS GROVE CIR
ORLANDO FL
32819-8010
US

IV. Provider business mailing address

7460 DOCS GROVE CIR
ORLANDO FL
32819-8010
US

V. Phone/Fax

Practice location:
  • Phone: 407-903-9360
  • Fax: 407-423-9505
Mailing address:
  • Phone: 407-423-7172
  • Fax: 407-423-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBBIE MACLAUGHLIN
Title or Position: ADMINISTRATION
Credential:
Phone: 407-423-7172