Healthcare Provider Details

I. General information

NPI: 1710483573
Provider Name (Legal Business Name): GIORGIO A NEGRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 130
HOLLYWOOD FL
33021-5424
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3985
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-7700
  • Fax: 954-276-0021
Mailing address:
  • Phone: 954-276-5685
  • Fax: 985-985-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME163666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: