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General NPI Number Information
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NPI Number | 1902090152
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Entity Type | Organization
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Legal Business Name | FLORIDA DETOX INC
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 1395 S PINELLAS AVE
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-3790
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Country | US
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Telephone | 352-867-8898
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Fax | 352-732-6282
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Provider Business Mailing Address
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Address Line | 1501 S PINELLAS AVE STE P SUITE P
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1952
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Country | US
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Telephone | 352-867-8898
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Fax | 352-732-6282
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Authorized Official
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Title or Position | MD
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Name | DR. MARVIN SPONAUGLE
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Credential |
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Telephone | 352-867-8898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | ME45587
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License Number State | FL
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