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General NPI Number Information
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NPI Number | 1881074805
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Entity Type | Organization
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Legal Business Name | TW FLORIDA STROKE NETWORK, INC.
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 26150 OLD 41 RD
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-6632
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Country | US
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Telephone | 239-231-1393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 548
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City | BONITA SPRINGS
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State | FL
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Zip | 34133-0548
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Country | US
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Telephone | 239-231-1393
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRAIN MASON
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Credential | M.D.
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Telephone | 239-231-1393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME78629
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME78629
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | ME78629
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License Number State | FL
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