MEDICARE: COMPREHENSIVE OBGYN CARE OF BCT

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	207V00000X	Obstetrics & Gynecology Physician	ME 32051	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821127929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE OBGYN CARE OF BCT

Provider Business Mailing Address
First Line	:	4959 N STATE ROAD 7
Second Line	:	SUITE A
City	:	TAMARAC
State	:	FL
Zip	:	33319-5871
Country	:	US
Telephone Number	:	754-245-8443
Fax Number	:

Provider Business Practice Location Address
First Line	:	4959 N STATE ROAD 7
Second Line	:	SUITE A
City	:	TAMARAC
State	:	FL
Zip	:	33319-5871
Country	:	US
Telephone Number	:	754-245-8443
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. LHERISSON DOMOND SR.
Credential	:	M.D.
Telephone Number	:	754-245-8443

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/30/2008

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