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General NPI Number Information
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NPI Number | 1073652665
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Entity Type | Organization
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Legal Business Name | N FLA SPORTS MEDICINE AND ORTHOPAEDIC CENTER PA
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 1911 MICCOSUKEE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5321
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Country | US
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Telephone | 850-878-2549
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Fax | 850-878-9334
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Provider Business Mailing Address
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Address Line | 1911 MICCOSUKEE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5321
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Country | US
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Telephone | 850-878-2549
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Fax | 850-212-9334
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER E LOEB
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Credential | MD
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Telephone | 850-878-2549
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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 |
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License Number State |
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