Healthcare Provider Details

I. General information

NPI: 1437138914
Provider Name (Legal Business Name): WOMEN'S SURGICAL SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 N FEDERAL HWY SUITE 402
FORT LAUDERDALE FL
33308-1412
US

IV. Provider business mailing address

6405 N FEDERAL HWY SUITE 402
FORT LAUDERDALE FL
33308-1412
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8888
  • Fax: 954-491-9485
Mailing address:
  • Phone: 954-771-8888
  • Fax: 954-491-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: E JASON GATES
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 954-771-8888