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General NPI Number Information
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NPI Number | 1700045069
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Entity Type | Organization
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Legal Business Name | SOUTHWEST FLORIDA SPINE INSTITUTE PLLC
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 3420 TAMIAMI TRL SUITE 1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8126
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Country | US
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Telephone | 941-979-7310
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 494409
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City | PORT CHARLOTTE
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State | FL
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Zip | 33949-4409
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Country | US
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Telephone | 941-979-7310
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARIO L PEREIRA
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Credential | MD
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Telephone | 941-979-7310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME98377
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License Number State | FL
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