Healthcare Provider Details

I. General information

NPI: 1609402619
Provider Name (Legal Business Name): BRO ROC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NE 59TH ST
FORT LAUDERDALE FL
33308-2443
US

IV. Provider business mailing address

1809 NE 59TH ST
FORT LAUDERDALE FL
33308-2443
US

V. Phone/Fax

Practice location:
  • Phone: 754-366-7735
  • Fax:
Mailing address:
  • Phone: 754-366-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY PAUL
Title or Position: FOUNDER
Credential:
Phone: 754-366-7735