Healthcare Provider Details

I. General information

NPI: 1811059009
Provider Name (Legal Business Name): PAUL H WAND MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 N UNIVERSITY DR STE 210
CORAL SPRINGS FL
33065-1405
US

IV. Provider business mailing address

2855 N UNIVERSITY DR STE 210
CORAL SPRINGS FL
33065-1405
US

V. Phone/Fax

Practice location:
  • Phone: 954-344-9772
  • Fax: 954-344-9760
Mailing address:
  • Phone: 954-344-9772
  • Fax: 954-344-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME 0041117
License Number StateFL

VIII. Authorized Official

Name: DR. PAUL HENRY WAND
Title or Position: PRESIDENT
Credential: M.D
Phone: 954-344-9772