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General NPI Number Information
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NPI Number | 1700827649
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Entity Type | Organization
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Legal Business Name | SPINE DIAGNOSTICS & INTERVENTIONAL CENTER INC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 2808 W DR MARTIN LUTHER KING JR BLVD
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City | TAMPA
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State | FL
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Zip | 33607-6306
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Country | US
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Telephone | 813-872-9200
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Fax | 813-875-5101
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Provider Business Mailing Address
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Address Line | PO BOX 152199
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City | TAMPA
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State | FL
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Zip | 33684-2199
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Country | US
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Telephone | 813-872-9200
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Fax | 813-875-5101
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. GREGORY T FLYNN
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Credential | M.D.
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Telephone | 813-872-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME37627
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License Number State | FL
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