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General NPI Number Information
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NPI Number | 1194098616
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Entity Type | Organization
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Legal Business Name | FLORIDA NEUROLOGY CLINICS PA
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 1258 W BAY DR STE H
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City | LARGO
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State | FL
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Zip | 33770-2242
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Country | US
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Telephone | 727-584-3313
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Fax | 727-584-3315
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Provider Business Mailing Address
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Address Line | 1258 WEST BAY DR. SUITE H
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City | LARGO
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State | FL
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Zip | 33770-2245
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Country | US
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Telephone | 727-584-3313
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Fax | 727-584-3315
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Authorized Official
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Title or Position | PRESIDENT
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Name | OBI OKONKWO-ONUIGBO
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Credential | M.D.
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Telephone | 727-584-3313
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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 | ME83217
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License Number State | FL
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