Provider Demographics
NPI:1700048170
Name:FLORIDA SPINE AND BRAIN
Entity Type:Organization
Organization Name:FLORIDA SPINE AND BRAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:SUDDERTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-275-6690
Mailing Address - Street 1:252 W MARION AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4435
Mailing Address - Country:US
Mailing Address - Phone:941-205-2417
Mailing Address - Fax:
Practice Address - Street 1:20 BARKLEY CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4545
Practice Address - Country:US
Practice Address - Phone:239-275-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty