Provider Demographics
NPI:1699966440
Name:NORTHWEST BROWARD NEUROSURGERY AND SPINE LLC
Entity type:Organization
Organization Name:NORTHWEST BROWARD NEUROSURGERY AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-548-3878
Mailing Address - Street 1:5901 COLONIAL DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5675
Mailing Address - Country:US
Mailing Address - Phone:954-973-4840
Mailing Address - Fax:
Practice Address - Street 1:5901 COLONIAL DR
Practice Address - Street 2:SUITE 311
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5675
Practice Address - Country:US
Practice Address - Phone:954-973-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLPENDINGMedicare PIN