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General NPI Number Information
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NPI Number | 1356305767
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Entity Type | Organization
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Legal Business Name | FLORIDA DIAGNOSTIC IMAGING INC
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 5201 BABCOCK ST NE SUITE 5
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City | PALM BAY
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State | FL
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Zip | 32905-4637
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Country | US
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Telephone | 321-676-5323
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Fax | 321-951-9253
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Provider Business Mailing Address
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Address Line | 5201 BABCOCK ST NE SUITE 5
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City | PALM BAY
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State | FL
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Zip | 32905-4637
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Country | US
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Telephone | 321-676-5323
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Fax | 321-951-9253
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IAN LANDIS
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Credential | DO
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Telephone | 321-676-5323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | HCC5282
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License Number State | FL
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