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General NPI Number Information
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NPI Number | 1235197930
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Entity Type | Organization
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Legal Business Name | FLORIDA DIAGNOSTIC IMAGING CENTER INC
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 4511 N DAVIS HWY SUITE 1-B
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City | PENSACOLA
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State | FL
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Zip | 32503-2720
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Country | US
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Telephone | 850-484-8454
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Fax | 850-484-7754
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Provider Business Mailing Address
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Address Line | 1642 WESTGATE CIR STE 202
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City | BRENTWOOD
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State | TN
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Zip | 37027-8195
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Country | US
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Telephone | 615-713-7519
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Fax |
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Authorized Official
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Title or Position | COO
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Name | RAIF ERIM
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Credential |
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Telephone | 615-713-7519
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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 |
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License Number State | FL
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