Healthcare Provider Details

I. General information

NPI: 1992990170
Provider Name (Legal Business Name): GREATER ORLANDO NEURSURGERY AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 STONEROCK CIR
ORLANDO FL
32819-8000
US

IV. Provider business mailing address

7340 STONEROCK CIR
ORLANDO FL
32819-8000
US

V. Phone/Fax

Practice location:
  • Phone: 407-355-0575
  • Fax:
Mailing address:
  • Phone: 407-355-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME75973
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME58900
License Number StateFL

VIII. Authorized Official

Name: MAX BRANDEN MEDARY
Title or Position: NEUROSURGEON
Credential: MD
Phone: 407-355-0575