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General NPI Number Information
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NPI Number | 1629438635
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Entity Type | Organization
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Legal Business Name | SPACE COAST LUNG & SLEEP CENTER
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 205 N BANANA RIVER DR SUITE 105
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-2596
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Country | US
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Telephone | 931-212-8192
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Fax |
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Provider Business Mailing Address
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Address Line | 205 N BANANA RIVER DR SUITE 105
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-2596
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Country | US
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Telephone | 931-212-8192
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MOHAMED MOATAZ TOBAN
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Credential | M.D.
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Telephone | 931-212-8192
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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 |
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License Number State | FL
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