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General NPI Number Information
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NPI Number | 1013003458
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Entity Type | Organization
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Legal Business Name | REGIONAL OSTEOPOROSIS CENTER OF STUART, LLC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2081 SE OCEAN BLVD SUITE 1A
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City | STUART
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State | FL
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Zip | 34996-3347
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Country | US
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Telephone | 772-286-9779
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Fax | 772-283-0287
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Provider Business Mailing Address
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Address Line | 2081 SE OCEAN BLVD SUITE 1A
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City | STUART
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State | FL
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Zip | 34996-3347
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Country | US
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Telephone | 772-286-9779
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Fax | 772-283-0287
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DARRELL N FISKE
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Credential | M.D.
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Telephone | 772-286-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | JR36022300
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License Number State | FL
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