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General NPI Number Information
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NPI Number | 1083943930
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Entity Type | Organization
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Legal Business Name | ADVANCED DIAGNOSTIC RESOURCES
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 500 UNIVERSITY BLVD SUITE 114
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City | JUPITER
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State | FL
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Zip | 33458-2773
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Country | US
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Telephone | 561-775-6600
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Fax | 561-775-6076
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Provider Business Mailing Address
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Address Line | 500 UNIVERSITY BLVD SUITE 107
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City | JUPITER
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State | FL
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Zip | 33458-2773
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Country | US
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Telephone | 561-775-6600
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Fax | 561-775-6076
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM ROUVEN MAGNUS
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Credential | ENGINEER
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Telephone | 561-775-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | HCC7308
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License Number State | FL
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