=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639365505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUND ORTHOPAEDICS & FOOT AND ANKLE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2007
-----------------------------------------------------
Last Update Date | 07/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8418 E BAY BLVD
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-939-5275
-----------------------------------------------------
Fax | 850-939-4152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8418 E BAY BLVD
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-939-5275
-----------------------------------------------------
Fax | 850-939-4152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MINOO H HOLLIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-939-5275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME68641
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------