Provider Demographics
NPI:1083943930
Name:ADVANCED DIAGNOSTIC RESOURCES
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROUVEN
Authorized Official - Last Name:MAGNUS
Authorized Official - Suffix:
Authorized Official - Credentials:ENGINEER
Authorized Official - Phone:561-775-6600
Mailing Address - Street 1:500 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2773
Mailing Address - Country:US
Mailing Address - Phone:561-775-6600
Mailing Address - Fax:561-775-6076
Practice Address - Street 1:500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2773
Practice Address - Country:US
Practice Address - Phone:561-775-6600
Practice Address - Fax:561-775-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC73082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA950AMedicare PIN