Organization
INSTITUTE OF DIAGNOSTIC IMAGING,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE BORGSTROM (OFFICE MANAGER)
(850) 314-7575
Entity
Organization
Contact information
Practice address
424 RACETRACK RD NW, FT WALTON BEACH, FL 32547-1556
(850) 314-7575
(850) 314-7494
Mailing address
424 RACETRACK RD NW, FORT WALTON BEACH, FL 32547-1556
(850) 314-7575
(850) 314-7494
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
602617
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268363600
—
FL
01
—
DB5733
RAILROAD MEDICARE
FL
Enumeration date
02/28/2006
Last updated
06/20/2014
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