Healthcare Provider Details

I. General information

NPI: 1164707782
Provider Name (Legal Business Name): SPINE & ORTHOPEDIC CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W DR MARTIN LUTHER KING JR BLVD SUITE 201
TAMPA FL
33603-3338
US

IV. Provider business mailing address

812 W DR MARTIN LUTHER KING JR BLVD SUITE 201
TAMPA FL
33603-3338
US

V. Phone/Fax

Practice location:
  • Phone: 813-224-9222
  • Fax: 813-224-9224
Mailing address:
  • Phone: 813-224-9222
  • Fax: 813-224-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME0061357
License Number StateFL

VIII. Authorized Official

Name: DR. GARY GEORGE MOSKOVITZ
Title or Position: PRES
Credential: M.D.
Phone: 813-224-9222