Provider Demographics
NPI:1578802658
Name:ADVANCED NEUROLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARRAU LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-400-2061
Mailing Address - Street 1:PO BOX 784986
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34778-4986
Mailing Address - Country:US
Mailing Address - Phone:407-255-8488
Mailing Address - Fax:407-255-8487
Practice Address - Street 1:1804 OAKLEY SEAVER DR
Practice Address - Street 2:SUITE C
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1925
Practice Address - Country:US
Practice Address - Phone:407-255-8488
Practice Address - Fax:407-255-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty