Organization
ADVANCE TECHNOLOGICAL RADIOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY T ROSA MD (OWNER)
(863) 421-9393
Entity
Organization
Contact information
Practice address
24040 US HIGHWAY 27, LAKE WALES, FL 33859-7813
(863) 456-2200
(863) 223-0858
Mailing address
PO BOX 2159, HAINES CITY, FL 33845-2159
(863) 421-9393
(863) 419-8774
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255768101
—
FL
Enumeration date
08/04/2021
Last updated
08/10/2021
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