Healthcare Provider Details

I. General information

NPI: 1528425204
Provider Name (Legal Business Name): JODY RITTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON ST STE 500A
HOLLYWOOD FL
33021-8256
US

IV. Provider business mailing address

3700 WASHINGTON ST STE 500A
HOLLYWOOD FL
33021-8256
US

V. Phone/Fax

Practice location:
  • Phone: 954-989-4700
  • Fax: 954-989-4754
Mailing address:
  • Phone: 954-989-4700
  • Fax: 954-989-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS16754
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS16754
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberOS16754
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0102206878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: