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General NPI Number Information
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NPI Number | 1306000443
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Entity Type | Organization
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Legal Business Name | SPECIALTY ORTHOPEDIC CENTER LLC
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 9325 GLADES RD SUITE 205
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City | BOCA RATON
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State | FL
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Zip | 33434-3988
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Country | US
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Telephone | 561-826-2000
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Fax | 561-826-2600
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Provider Business Mailing Address
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Address Line | 9325 GLADES RD SUITE 205
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City | BOCA RATON
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State | FL
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Zip | 33434-3988
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Country | US
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Telephone | 561-826-2000
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Fax | 561-826-2600
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHATINA MARIE CANNON
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Credential |
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Telephone | 561-826-2000
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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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