Basic Information
Provider Information | |||||||||
NPI: | 1538565122 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | JOINT & SPINE MEDICAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2151 E COMMERCIAL BLVD | ||||||||
Address2: | SUITE 303 | ||||||||
City: | FT LAUDERDALE | ||||||||
State: | FL | ||||||||
PostalCode: | 333083807 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9549070370 | ||||||||
FaxNumber: | 9545338500 | ||||||||
Practice Location | |||||||||
Address1: | 2151 E COMMERCIAL BLVD | ||||||||
Address2: | SUITE 303 | ||||||||
City: | FT LAUDERDALE | ||||||||
State: | FL | ||||||||
PostalCode: | 333083807 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9549070370 | ||||||||
FaxNumber: | 9545338500 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/10/2014 | ||||||||
LastUpdateDate: | 11/10/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ANSCHUETZ | ||||||||
AuthorizedOfficialFirstName: | DANNELL | ||||||||
AuthorizedOfficialMiddleName: | B | ||||||||
AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
AuthorizedOfficialTelephone: | 9549070370 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | D.O. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | OS8932 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.