1295090041 NPI number — BROWARD MEDICAL PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295090041 NPI number — BROWARD MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWARD MEDICAL PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295090041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3410 STALLION LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33331-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-218-5395
Provider Business Mailing Address Fax Number:
786-441-4365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6261 W ATLANTIC BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-218-5395
Provider Business Practice Location Address Fax Number:
786-441-4365
Provider Enumeration Date:
07/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAFFER
Authorized Official First Name:
FAUZIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-218-5395

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)