Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jun 11, 2006
License(s)
ME0091230 (FL), ME0091230 (FL), 103865 (GA), ME0091230 (FL), ME0091230 (FL), ME0091230 (FL), ME0091230 (FL), ME0091230 (FL), ME0091230 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1673 MASON AVE STE 305 | Daytona Beach, FL 32117-5516 | 386-274-7118 |
| LOCATION | 1673 MASON AVE SUITE # 305 | Daytona Beach, FL 32117-5515 | 386-274-7118 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.