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General NPI Number Information
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NPI Number | 1841422581
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Entity Type | Organization
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Legal Business Name | PALM HARBOR ORTHOPEDICS PA
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 80 PINNACLES DR SUITE 700
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City | PALM COAST
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State | FL
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Zip | 32164-2323
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Country | US
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Telephone | 386-586-2234
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Fax | 386-586-2884
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Provider Business Mailing Address
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Address Line | PO BOX 352077
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City | PALM COAST
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State | FL
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Zip | 32135-2077
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Country | US
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Telephone | 386-586-2234
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Fax | 386-586-2884
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. RONALD BATHAW
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Credential | M.D.
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Telephone | 386-586-2234
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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 | ME004566
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License Number State | FL
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