Healthcare Provider Details

I. General information

NPI: 1962461558
Provider Name (Legal Business Name): CENTER FOR CRANIAL/SPINAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SE RIVERSIDE DR STE 203
STUART FL
34994-2579
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-5862
  • Fax: 772-288-5874
Mailing address:
  • Phone: 772-223-5665
  • Fax: 772-223-5646

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: ROBERT LESTER LORD
Title or Position: PRESIDENT
Credential:
Phone: 772-223-5945