Provider Demographics
NPI:1942746763
Name:FL SPINE & MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:FL SPINE & MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-799-2225
Mailing Address - Street 1:1531 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2236
Mailing Address - Country:US
Mailing Address - Phone:727-799-2225
Mailing Address - Fax:727-799-2226
Practice Address - Street 1:1531 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2236
Practice Address - Country:US
Practice Address - Phone:727-799-2225
Practice Address - Fax:727-799-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty