Healthcare Provider Details

I. General information

NPI: 1073997151
Provider Name (Legal Business Name): SPINE SPECIALISTS OF SOUTH FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2047 PALM BEACH LAKES BLVD
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 Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME58528
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS10573
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME73142
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME53603
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME73142
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME123443
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME58528
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME73142
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME54695
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME53603
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME92323
License Number StateFL
# 12
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: D.P.M.
Phone: 561-312-9336