Healthcare Provider Details

I. General information

NPI: 1225378516
Provider Name (Legal Business Name): JOHN BANCROFT HYLTON M.D,P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12323 SW 55TH ST SUITE 1003
COOPER CITY FL
33330-3312
US

IV. Provider business mailing address

12323 SW 55TH ST SUITE 1003
COOPER CITY FL
33330-3312
US

V. Phone/Fax

Practice location:
  • Phone: 954-252-0083
  • Fax: 954-252-0207
Mailing address:
  • Phone: 954-252-0083
  • Fax: 954-252-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME0060538
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN BANCROFT HYLTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-252-0083