Healthcare Provider Details

I. General information

NPI: 1689949224
Provider Name (Legal Business Name): ORTHO FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 COCONUT CREEK PKWY SUITE 303
COCONUT CREEK FL
33066-1652
US

IV. Provider business mailing address

9325 GLADES RD SUITE 205
BOCA RATON FL
33434-3988
US

V. Phone/Fax

Practice location:
  • Phone: 561-826-2000
  • Fax: 561-826-2600
Mailing address:
  • Phone: 561-826-2000
  • Fax: 561-826-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHATINA CANNON
Title or Position: MANAGER
Credential:
Phone: 561-826-2000