Provider Demographics
NPI:1346303930
Name:NEUROLOGY SPECIALISTS, PA.
Entity Type:Organization
Organization Name:NEUROLOGY SPECIALISTS, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:X
Authorized Official - Last Name:NORLEANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-590-9190
Mailing Address - Street 1:9730 COMMERCE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3615
Mailing Address - Country:US
Mailing Address - Phone:239-590-9190
Mailing Address - Fax:239-989-0166
Practice Address - Street 1:9730 COMMERCE CENTER CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3615
Practice Address - Country:US
Practice Address - Phone:239-590-9190
Practice Address - Fax:239-989-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME87954OtherLICENSE
FLP00162627OtherRAILROAD MEDICARE
FLK5868Medicare PIN
FLME87954OtherLICENSE