Healthcare Provider Details

I. General information

NPI: 1114250453
Provider Name (Legal Business Name): FLORIDA RADIOLOGY SPECIALISTS, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 EVENTIDE PL
STUART FL
34994-9143
US

IV. Provider business mailing address

200 KNUTH RD STE 200
BOYNTON BEACH FL
33436-4693
US

V. Phone/Fax

Practice location:
  • Phone: 561-736-1200
  • Fax: 561-742-1919
Mailing address:
  • Phone: 561-736-1200
  • Fax: 561-742-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH T CHARLES
Title or Position: PARTNER
Credential: MD
Phone: 561-736-1200