Provider Demographics
NPI:1093123127
Name:INTERVENTIONAL SPINE INSTITUTE OF FLORIDA
Entity Type:Organization
Organization Name:INTERVENTIONAL SPINE INSTITUTE OF FLORIDA
Other - Org Name:SPINE, ORTHOPEDICS AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOWDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-733-0064
Mailing Address - Street 1:308 S HARBOR CITY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1500
Mailing Address - Country:US
Mailing Address - Phone:321-733-0064
Mailing Address - Fax:321-733-7970
Practice Address - Street 1:1315 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 1111
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1407
Practice Address - Country:US
Practice Address - Phone:321-733-0064
Practice Address - Fax:321-733-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60952208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10708014OtherCAQH
FL1326453143OtherNPI-DME-MELBOURNE
FLME76009OtherMEDICAL LICENSE
FL1225060338OtherNPI GROUP
FL1639101744OtherNPI INDIVIDUAL
FLK5708OtherMEDICARE GROUP
FLK5708OtherMEDICARE GROUP
FLME76009OtherMEDICAL LICENSE