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Organization
ST. GEORGE SPINAL CLINIC PA
Active
Organization
ST. GEORGE SPINAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAGDY B. TADROS MD (PHYSICIAN)
(954) 486-1966
Entity
Organization
Contact information
Practice address
4469 N STATE ROAD 7, LAUDERDALE LAKES, FL 33319-5876
(954) 486-1966
(954) 486-9115
Mailing address
PO BOX 10693, RIVIERA BEACH, FL 33419-0693
(954) 486-1966
(954) 486-9115
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME65248
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
234955
AVMED
FL
01
—
25940
BCBS ID
FL
01
—
2621902
AETNA
FL
Enumeration date
07/25/2006
Last updated
08/26/2011
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