Healthcare Provider Details

I. General information

NPI: 1982957841
Provider Name (Legal Business Name): EDUARDO J HIDALGO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 N OCEAN BLVD SECOND FLOOR
FT LAUDERDALE FL
33308-6420
US

IV. Provider business mailing address

4006 N OCEAN BLVD SECOND FLOOR
FT LAUDERDALE FL
33308-6420
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-4006
  • Fax: 954-566-1960
Mailing address:
  • Phone: 954-566-4006
  • Fax: 954-566-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDUARDO JOSE HIDALGO
Title or Position: PRESIDENT
Credential: MD
Phone: 954-566-4006