Provider Demographics
NPI:1851847651
Name:FLORIDA MUSCULOSKELETAL SURGICAL GROUP LLC
Entity Type:Organization
Organization Name:FLORIDA MUSCULOSKELETAL SURGICAL GROUP LLC
Other - Org Name:BRANDON ORTHOPEDIC ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:OKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-684-3707
Mailing Address - Street 1:721 W ROBERTSON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4900
Mailing Address - Country:US
Mailing Address - Phone:813-684-3707
Mailing Address - Fax:813-643-2457
Practice Address - Street 1:10141 BIG BEND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7419
Practice Address - Country:US
Practice Address - Phone:813-684-3707
Practice Address - Fax:813-654-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6735700008Medicare NSC