Basic Information
| Provider Information | |||||||||
| NPI: | 1497141733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHO FLORIDA, LLC | ||||||||
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| OtherOrganizationName: | TODD ALEA, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 GLADES RD | ||||||||
| Address2: | STE 460 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613001792 | ||||||||
| FaxNumber: | 5613001892 | ||||||||
| Practice Location | |||||||||
| Address1: | 2804 NE 8TH ST | ||||||||
| Address2: | STE 203 | ||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330335613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862432951 | ||||||||
| FaxNumber: | 7862432951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2015 | ||||||||
| LastUpdateDate: | 04/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | TRASK | ||||||||
| AuthorizedOfficialFirstName: | DANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8137871128 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ORTHO FLORIDA, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | ME86935 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.