Provider Demographics
NPI:1164707782
Name:SPINE & ORTHOPEDIC CENTER, P.A.
Entity Type:Organization
Organization Name:SPINE & ORTHOPEDIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MOSKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-224-9222
Mailing Address - Street 1:812 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3338
Mailing Address - Country:US
Mailing Address - Phone:813-224-9222
Mailing Address - Fax:813-224-9224
Practice Address - Street 1:812 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3338
Practice Address - Country:US
Practice Address - Phone:813-224-9222
Practice Address - Fax:813-224-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061357207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF34614Medicare UPIN
FL17801XMedicare PIN