MEDICARE: CUTTING EDGE MEDICAL GR

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	207Q00000X	Family Medicine Physician	OS0003995	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82312	OTHER	FL	BLUE CROSS BLUE SHIELD FL

General Provider Information

NPI Number	:	1326171299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTTING EDGE MEDICAL GR

Provider Business Mailing Address
First Line	:	2425 E COMMERCIAL BLVD
Second Line	:	SUITE 200
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4034
Country	:	US
Telephone Number	:	954-776-3415
Fax Number	:	954-776-3417

Provider Business Practice Location Address
First Line	:	2425 E COMMERCIAL BLVD
Second Line	:	SUITE 200
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4034
Country	:	US
Telephone Number	:	954-776-3415
Fax Number	:	954-776-3417

Authorized Official
Title or Position	:	OWNER
Name	:	DONALD D FISHER
Credential	:	D.O.
Telephone Number	:	954-776-3415

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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Directions to “CUTTING EDGE MEDICAL GR ” Practice Location

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