Healthcare Provider Details
I. General information
NPI: 1285646547
Provider Name (Legal Business Name): BROWARD INSTITUTE OF ORTHOPAEDIC SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/13/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4310 SHERIDAN ST
HOLLYWOOD FL
33021-3554
US
IV. Provider business mailing address
4440 SHERIDAN ST
HOLLYWOOD FL
33021-3535
US
V. Phone/Fax
- Phone: 954-989-3500
- Fax:
- Phone: 954-962-3508
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207X00000X |
| Taxonomy | Orthopaedic Surgery Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JEFFREY
WORTH
Title or Position: OWNER
Credential: MD
Phone: 954-962-3508