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General NPI Number Information
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NPI Number | 1457468548
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Entity Type | Organization
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Legal Business Name | NEUROLOGY CLINIC PA
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 1333 PINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3116
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Country | US
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Telephone | 321-984-9400
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Fax | 321-984-8782
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Provider Business Mailing Address
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Address Line | 1333 PINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3116
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Country | US
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Telephone | 321-984-9400
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Fax | 321-984-8782
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J PACKEY
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Credential | PHD MD
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Telephone | 321-984-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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