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General NPI Number Information
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NPI Number | 1417943846
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Entity Type | Organization
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Legal Business Name | HIGHLAND CENTER FOR ORTHOPEDICS & UPPER EXTREMITY SURGERY P A
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 3317 US HIGHWAY 98 S STE 9
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City | LAKELAND
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State | FL
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Zip | 33803-8316
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Country | US
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Telephone | 863-709-8777
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Fax | 863-709-1060
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Provider Business Mailing Address
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Address Line | 3317 US HIGHWAY 98 S STE 9
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City | LAKELAND
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State | FL
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Zip | 33803-8316
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Country | US
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Telephone | 863-709-8777
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Fax | 863-709-1060
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN MICHAEL JURBALA
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Credential | MD
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Telephone | 863-709-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | ME70116
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License Number State | FL
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