Organization
ORTHO FLORIDA, LLC
Active
Parent organization
ORTHO FLORIDA, LLC
Other names
J Provo, MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORTHO FLORIDA, LLC
Authorized official
DANE TRASK (COO)
(813) 787-1128
Entity
Organization
Contact information
Practice address
4705 N FEDERAL HWY, BOCA RATON, FL 33431-4953
(561) 405-9610
Mailing address
751 PARK OF COMMERCE DR, STE 112, BOCA RATON, FL 33487-3626
(561) 300-1792
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Enumeration date
09/15/2014
Last updated
10/02/2015
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