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General NPI Number Information
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NPI Number | 1407969678
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN NEUROSURGERY, PA
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 532 VIRGINIA DR
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City | ORLANDO
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State | FL
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Zip | 32803-1856
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Country | US
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Telephone | 407-898-8644
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Fax | 407-898-8646
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Provider Business Mailing Address
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Address Line | 532 VIRGINIA DR
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City | ORLANDO
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State | FL
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Zip | 32803-1856
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Country | US
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Telephone | 407-898-8644
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Fax | 407-898-8646
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Authorized Official
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Title or Position | CEO
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Name | DR. PHILLIP G ST LOUIS
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Credential | M.D.
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Telephone | 407-898-8644
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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 | ME42806
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License Number State | FL
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