Provider Demographics
NPI:1760511356
Name:PALM BEACH BRAIN AND SPINE LLC
Entity Type:Organization
Organization Name:PALM BEACH BRAIN AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-661-3365
Mailing Address - Street 1:4631 N CONGRESS AVE
Mailing Address - Street 2:SUITE 202 - 110
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3209
Mailing Address - Country:US
Mailing Address - Phone:561-844-0120
Mailing Address - Fax:561-844-0570
Practice Address - Street 1:4631 N CONGRESS AVE
Practice Address - Street 2:SUITE 202 - 110
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3209
Practice Address - Country:US
Practice Address - Phone:561-844-0120
Practice Address - Fax:561-844-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty