Organization
THE HEADACHE AND NEUROLOGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. QAHTAN ABDULFATTAH MD (PRESIDENT)
(352) 596-8344
Entity
Organization
Contact information
Practice address
11373 CORTEZ BLVD STE 303, 303, BROOKSVILLE, FL 34613-5411
(352) 596-8344
(352) 597-2898
Mailing address
11373 CORTEZ BLVD STE 303, BROOKSVILLE, FL 34613-5411
(352) 596-8344
(352) 597-2898
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
ME92671
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558370411
PROVIDER'S INDIVIDUAL NPI
—
Enumeration date
03/08/2007
Last updated
07/06/2010
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