MEDICARE: ORTHOPEDIC TRAUMA CONSULTANTS, LLC

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	207XX0801X	Orthopaedic Trauma Physician

General Provider Information

NPI Number	:	1295420479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC TRAUMA CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	1649 VICTORIA POINTE CIR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-1311
Country	:	US
Telephone Number	:	954-812-1388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1649 VICTORIA POINTE CIR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-1311
Country	:	US
Telephone Number	:	954-812-1388
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	DR. BRIAN J CROSS
Credential	:	DO
Telephone Number	:	954-812-1388

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/05/2023

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