MEDICARE: MD SPINAL CARE LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	ME92323	FL

General Provider Information

NPI Number	:	1104229814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD SPINAL CARE LTD

Provider Business Mailing Address
First Line	:	11412 OKEECHOBEE BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-8722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 LANTANA RD
Second Line	:	SUITE 100
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2246
Country	:	US
Telephone Number	:	561-408-9006
Fax Number	:	561-246-3996

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JONATHAN CUTLER
Credential	:	M.D.
Telephone Number	:	561-408-9006

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	10/08/2014

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