Organization
ORTHOPEDIC CENTER FOR SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT MATHIS (ADMINISTRATOR)
(863) 421-7411
Entity
Organization
Contact information
Practice address
105 PARK PLACE BLVD, SUITE A, DAVENPORT, FL 33837-6858
(863) 421-7411
(863) 547-9514
Mailing address
105 PARK PLACE BLVD, SUITE A, DAVENPORT, FL 33837-6858
(863) 421-7411
(863) 547-9514
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME72924
FL
Other
Enumeration date
08/01/2013
Last updated
01/19/2016
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