MEDICARE: DOCTORS NEUROLOGICAL SERVICES OF FT LAUDERDALE INC

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	2084N0600X	Clinical Neurophysiology Physician

General Provider Information

NPI Number	:	1316246796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS NEUROLOGICAL SERVICES OF FT LAUDERDALE INC

Provider Business Mailing Address
First Line	:	1452 N US HIGHWAY 1
Second Line	:	SUITE 103
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-6638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1452 N US HIGHWAY 1
Second Line	:	SUITE 103
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-6638
Country	:	US
Telephone Number	:	138-684-6269
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT HARGRAVE
Credential	:
Telephone Number	:	386-846-2698

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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