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General NPI Number Information
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NPI Number | 1104229814
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Entity Type | Organization
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Legal Business Name | MD SPINAL CARE LTD
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 3618 LANTANA RD SUITE 100
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City | LAKE WORTH
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State | FL
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Zip | 33462-2246
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Country | US
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Telephone | 561-408-9006
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Fax | 561-246-3996
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Provider Business Mailing Address
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Address Line | 11412 OKEECHOBEE BLVD
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-8722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN CUTLER
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Credential | M.D.
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Telephone | 561-408-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME92323
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License Number State | FL
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