Healthcare Provider Details

I. General information

NPI: 1760338842
Provider Name (Legal Business Name): ENT FACULTY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD
DEERFIELD BEACH FL
33064-3502
US

IV. Provider business mailing address

2307 W BROWARD BLVD STE 201
FT LAUDERDALE FL
33312-1420
US

V. Phone/Fax

Practice location:
  • Phone: 954-444-0668
  • Fax:
Mailing address:
  • Phone: 954-444-0668
  • Fax: 954-541-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILSON DUMORNAY
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 954-675-4401