Healthcare Provider Details

I. General information

NPI: 1194199745
Provider Name (Legal Business Name): SPINE AND NEUROSURGICAL SPECIALISTS OF SOUTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 PALM BEACH LAKES BLVD STE 100
WEST PALM BEACH FL
33409-6522
US

IV. Provider business mailing address

2047 PALM BEACH LAKES BLVD STE 100
WEST PALM BEACH FL
33409-6522
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-0800
  • Fax:
Mailing address:
  • Phone: 561-507-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME123443
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0073142
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME0053603
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME0073142
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME0073142
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME0053603
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME114075
License Number StateFL

VIII. Authorized Official

Name: JONATHAN CUTLER
Title or Position: PRESIDENT
Credential: DPM
Phone: 561-312-9336