Healthcare Provider Details

I. General information

NPI: 1316246796
Provider Name (Legal Business Name): DOCTORS NEUROLOGICAL SERVICES OF FT LAUDERDALE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 N US HIGHWAY 1 SUITE 103
ORMOND BEACH FL
32174-6638
US

IV. Provider business mailing address

1452 N US HIGHWAY 1 SUITE 103
ORMOND BEACH FL
32174-6638
US

V. Phone/Fax

Practice location:
  • Phone: 138-684-6269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT HARGRAVE
Title or Position: PRESIDENT
Credential:
Phone: 386-846-2698