Healthcare Provider Details

I. General information

NPI: 1326205642
Provider Name (Legal Business Name): FORT LAUDERDALE ORTHOPAEDICS PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 NE 47TH ST STE 102
FT LAUDERDALE FL
33308
US

IV. Provider business mailing address

1960 NE 47TH ST STE 102
FT LAUDERDALE FL
33308-7708
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-3200
  • Fax: 954-463-3292
Mailing address:
  • Phone: 954-463-3200
  • Fax: 954-463-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME44143
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberME44143
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME44143
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL J RUDDY
Title or Position: CEO
Credential:
Phone: 954-463-3200