Provider Demographics
NPI:1962497669
Name:FLORIDA NEUROLOGY GROUP P L
Entity Type:Organization
Organization Name:FLORIDA NEUROLOGY GROUP P L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-936-3554
Mailing Address - Street 1:12670 WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3619
Mailing Address - Country:US
Mailing Address - Phone:239-936-3554
Mailing Address - Fax:239-936-8993
Practice Address - Street 1:12670 WHITEHALL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3619
Practice Address - Country:US
Practice Address - Phone:239-936-3554
Practice Address - Fax:239-936-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21303Medicare UPIN