Organization
SPINE CENTER OF FL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS W WISOR MD (OFFICER)
(703) 927-5772
Entity
Organization
Contact information
Practice address
9400 BONITA BEACH RD SE STE 101, BONITA SPRINGS, FL 34135-4520
(239) 333-1177
(239) 333-1169
Mailing address
11921 ROCKVILLE PIKE STE 505, ROCKVILLE, MD 20852-2758
(301) 945-5111
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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