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General NPI Number Information
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NPI Number | 1609841402
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Entity Type | Organization
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Legal Business Name | STAND UP MRI OF TALLAHASSEE PA
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 2332 CAPITAL CIR NE
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4308
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Country | US
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Telephone | 850-385-6422
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Fax | 850-422-8993
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Provider Business Mailing Address
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Address Line | 2332 CAPITAL CIR NE
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4308
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Country | US
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Telephone | 850-385-6422
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Fax | 850-422-8993
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | LLOYD WAXMAN
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Credential |
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Telephone | 631-694-2816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 31470
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License Number State | FL
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