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General NPI Number Information
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NPI Number | 1629766969
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Entity Type | Organization
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Legal Business Name | MIS NEUROSPINE LLC
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 12468 BRANTLEY COMMONS CT
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City | FORT MYERS
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State | FL
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Zip | 33907-5663
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Country | US
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Telephone | 239-236-8933
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Fax | 407-650-2731
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Provider Business Mailing Address
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Address Line | 1711 AMAZING WAY STE 209
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City | OCOEE
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State | FL
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Zip | 34761-3491
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Country | US
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Telephone | 239-236-8933
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CURTIS LEE BEAUREGARD
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Credential | MD
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Telephone | 239-236-8933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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