Healthcare Provider Details

I. General information

NPI: 1730111287
Provider Name (Legal Business Name): JOSHUA MARC RYCUS D.O.,P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 NW 33RD ST SUITE # 114
CORAL SPRINGS FL
33065-4042
US

IV. Provider business mailing address

9750 NW 33RD ST SUITE # 114
CORAL SPRINGS FL
33065-4042
US

V. Phone/Fax

Practice location:
  • Phone: 954-753-1477
  • Fax: 954-753-3626
Mailing address:
  • Phone: 954-753-1477
  • Fax: 954-753-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS 8863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: