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General NPI Number Information
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NPI Number | 1841315983
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Entity Type | Organization
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Legal Business Name | FLORIDA SPINE CENTER PA
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 2030 DREW ST
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City | CLEARWATER
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State | FL
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Zip | 33765-3117
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Country | US
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Telephone | 727-462-5582
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Fax | 727-462-5583
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Provider Business Mailing Address
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Address Line | PO BOX 6171
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City | CLEARWATER
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State | FL
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Zip | 33758-6171
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Country | US
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Telephone | 727-462-5582
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Fax | 727-462-5583
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENNIS MARSHALL LOX
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Credential | MD
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Telephone | 727-462-5582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 57943
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License Number State | FL
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