Healthcare Provider Details

I. General information

NPI: 1770254385
Provider Name (Legal Business Name): ORTHO FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W COMMERCIAL BLVD STE 101
FORT LAUDERDALE FL
33309-3424
US

IV. Provider business mailing address

433 PLAZA REAL STE 275
BOCA RATON FL
33432-3999
US

V. Phone/Fax

Practice location:
  • Phone: 954-751-6990
  • Fax:
Mailing address:
  • Phone: 561-300-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANE TRASK
Title or Position: CEO
Credential:
Phone: 813-747-1128