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General NPI Number Information
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NPI Number | 1417040270
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC REGIONAL BONE & SPORTS MEDICINE
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 9401 SW HIGHWAY 200 STE 201
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City | OCALA
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State | FL
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Zip | 34481-9610
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Country | US
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Telephone | 352-291-2707
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Fax | 352-291-2709
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Provider Business Mailing Address
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Address Line | 9401 SW HIGHWAY 200 STE 201
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City | OCALA
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State | FL
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Zip | 34481-9610
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Country | US
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Telephone | 352-291-2707
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Fax | 352-291-2709
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGEL RAFAEL ROURE
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Credential | MD
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Telephone | 352-291-2707
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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 | ME72475
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License Number State | FL
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