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General NPI Number Information
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NPI Number | 1962461558
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Entity Type | Organization
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Legal Business Name | CENTER FOR CRANIAL/SPINAL SURGERY
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 509 SE RIVERSIDE DR STE 203
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City | STUART
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State | FL
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Zip | 34994-2579
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Country | US
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Telephone | 772-288-5862
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Fax | 772-288-5874
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Provider Business Mailing Address
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Address Line | PO BOX 417
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City | STUART
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State | FL
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Zip | 34995-0417
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Country | US
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Telephone | 772-223-5665
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Fax | 772-223-5646
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT LESTER LORD
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Credential |
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Telephone | 772-223-5945
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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 |
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License Number State |
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