MEDICARE: PERFORMANCE ORTHOPAEDIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		FL

General Provider Information

NPI Number	:	1043462799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE ORTHOPAEDIC

Provider Business Mailing Address
First Line	:	721 SE 17TH ST
Second Line	:	#104
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2983
Country	:	US
Telephone Number	:	954-765-3200
Fax Number	:	786-975-2643

Provider Business Practice Location Address
First Line	:	721 SE 17TH ST
Second Line	:	#104
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2983
Country	:	US
Telephone Number	:	954-765-3200
Fax Number	:	786-975-2643

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN MEVORAH
Credential	:
Telephone Number	:	954-765-3200

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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Directions to “PERFORMANCE ORTHOPAEDIC ” Practice Location

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