MEDICARE: VOLUSIA NEUROLOGIC ASSOCIATES, P.A.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1134137367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOLUSIA NEUROLOGIC ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	405 DOWNING ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7109
Country	:	US
Telephone Number	:	386-427-3700
Fax Number	:	386-427-1890

Provider Business Practice Location Address
First Line	:	405 DOWNING ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7109
Country	:	US
Telephone Number	:	386-427-3700
Fax Number	:	386-427-1890

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. GALE L BOWSER
Credential	:
Telephone Number	:	386-427-3700

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	10/10/2007

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