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General NPI Number Information
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NPI Number | 1639269392
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Entity Type | Organization
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Legal Business Name | NORTH BRANDON IMAGING LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 613 OAKFIELD DRIVE
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City | BRADON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-661-2222
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Fax | 813-681-8494
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Provider Business Mailing Address
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Address Line | 613 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5714
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Country | US
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Telephone | 813-661-2222
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Fax | 813-681-8494
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Authorized Official
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Title or Position | SENIOR VP
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Name | MR. WILLIAM B. RUTHERFORD
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Credential |
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Telephone | 615-309-2190
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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 |
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License Number State |
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