1205316585 NPI number — SPECIALITY AT PAUL G. PRESTE MD & ASSOCIATES, LLC

Table of content: (NPI 1205316585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205316585 NPI number — SPECIALITY AT PAUL G. PRESTE MD & ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALITY AT PAUL G. PRESTE MD & ASSOCIATES, LLC
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:
6
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:
1205316585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3075 E COMMERCIAL BLVD STE 1A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-4318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-491-6200
Provider Business Mailing Address Fax Number:
954-491-6419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3075 E COMMERCIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-491-6200
Provider Business Practice Location Address Fax Number:
954-491-6419
Provider Enumeration Date:
08/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDEN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
954-491-6200

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  ME134189 , 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: K6RRB . This is a "FLORIDA BLUE PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com