Organization
BRAIN AND SPINE INSTATE FOR CHILDREN
Active
Other names
Basic
Organization subpart
No
Provider details
NPI number
Authorized official
KEYNE K JOHNSON M.D. (MEDICAL DIRECTOR)
(407) 378-5100
Entity
Organization
Contact information
Practice address
2813 S HIAWASSEE RD, SUITE 201, ORLANDO, FL 32835-6300
(407) 378-5100
Mailing address
2813 S HIAWASSEE RD, SUITE 201, ORLANDO, FL 32835-6300
(407) 378-5100
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
ME 102412
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000384900
—
FL
Enumeration date
02/19/2013
Last updated
02/19/2013
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