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General NPI Number Information
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NPI Number | 1063631133
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Entity Type | Organization
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Legal Business Name | NATURE COAST NEUROSUGERY INC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 13911 LAKESHORE BLVD
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City | HUDSON
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State | FL
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Zip | 34667-7102
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Country | US
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Telephone | 727-862-1234
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Fax | 727-862-1616
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Provider Business Mailing Address
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Address Line | 13911 LAKESHORE BLVD
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City | HUDSON
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State | FL
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Zip | 34667-7102
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Country | US
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Telephone | 727-862-1234
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Fax | 727-862-1616
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAYNE L WITTENBERG
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Credential | MD
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Telephone | 727-862-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME94451
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License Number State | FL
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