Healthcare Provider Details

I. General information

NPI: 1255049557
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP OF FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 BAPTIST CLAY DR
FLEMING ISLAND FL
32003-8502
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 904-516-1000
  • Fax:
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-527-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS E. GLASER
Title or Position: PRESIDENT
Credential:
Phone: 800-243-3839