1548238462 NPI number — DR. FRANK JOHN VITTIMBERGA JR. M.D.

Table of content: DR. FRANK JOHN VITTIMBERGA JR. M.D. (NPI 1548238462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548238462 NPI number — DR. FRANK JOHN VITTIMBERGA JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VITTIMBERGA
Provider First Name:
FRANK
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VITTIMBERGA
Provider Other First Name:
FRANK
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548238462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 W OAKLAND PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUDERDALE LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33313-1585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-625-3611
Provider Business Mailing Address Fax Number:
214-239-4964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 NE 19TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILTON MANORS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-890-3757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME124839 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 178673301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".