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General NPI Number Information
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NPI Number | 1114318326
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Entity Type | Organization
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Legal Business Name | FLORIDA ORTHOPAEDIC TRAUMA SPECIALISTS, PLLC
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 7544 JACQUE RD
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City | HUDSON
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State | FL
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Zip | 34667-7162
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Country | US
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Telephone | 727-868-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 7544 JACQUE RD
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City | HUDSON
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State | FL
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Zip | 34667-7162
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Country | US
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Telephone | 727-868-5222
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | CRAIG BENNETT
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Credential | MD
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Telephone | 727-868-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number |
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License Number State |
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