Healthcare Provider Details

I. General information

NPI: 1093950008
Provider Name (Legal Business Name): HIMMERSHEE SURGICAL PARTNERS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 SE 2ND ST
FORT LAUDERDALE FL
33301-3605
US

IV. Provider business mailing address

717 SE 2ND ST
FORT LAUDERDALE FL
33301-3605
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-5208
  • Fax: 954-337-3309
Mailing address:
  • Phone: 954-357-1172
  • Fax: 954-337-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME51849
License Number StateFL

VIII. Authorized Official

Name: HARRY K MOON
Title or Position: PHYSICIAN
Credential: MD
Phone: 954-357-1172