Healthcare Provider Details

I. General information

NPI: 1891447694
Provider Name (Legal Business Name): PRIORITY HEALTH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 SHERIDAN ST STE 120
HOLLYWOOD FL
33024-3086
US

IV. Provider business mailing address

4765 SW 148TH AVE
DAVIE FL
33330-2127
US

V. Phone/Fax

Practice location:
  • Phone: 954-589-1198
  • Fax:
Mailing address:
  • Phone: 954-374-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERTO FERNANDEZ-BLAY
Title or Position: DIRECTOR
Credential: MD
Phone: 954-890-2524