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General NPI Number Information
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NPI Number | 1962910455
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Entity Type | Organization
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Legal Business Name | THE SOLE AUTHORITY
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 8307 NW 88TH AVE
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City | TAMARAC
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State | FL
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Zip | 33321
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Country | US
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Telephone | 954-721-3411
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Fax | 954-721-3772
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Provider Business Mailing Address
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Address Line | 8307 NW 88TH AVE
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City | TAMARAC
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State | FL
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Zip | 33321-1539
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Country | US
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Telephone | 954-721-3411
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Fax | 954-721-3772
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURA WHITE
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Credential | DPM
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Telephone | 954-721-3411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2770
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License Number State | FL
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