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General NPI Number Information
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NPI Number | 1538367636
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Entity Type | Organization
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Legal Business Name | NORTHWEST BROWARD NEUROSURGERY AND SPINE, LLC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 2960 N STATE ROAD 7 SUITE 206
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City | MARGATE
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State | FL
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Zip | 33063-5755
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Country | US
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Telephone | 561-548-3716
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Fax | 561-548-3878
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Provider Business Mailing Address
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Address Line | 111 JFK DR STE A
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City | ATLANTIS
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State | FL
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Zip | 33462-6634
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Country | US
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Telephone | 561-548-3716
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Fax | 561-548-3878
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | COURTNEY A JAHN
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Credential |
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Telephone | 561-251-9995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME99266
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License Number State | FL
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