Healthcare Provider Details

I. General information

NPI: 1467118745
Provider Name (Legal Business Name): UROLOGY PROFESSIONALS OF SOUTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 HOLLYWOOD BLVD STE 3A
HOLLYWOOD FL
33021-6736
US

IV. Provider business mailing address

3700 WASHINGTON ST STE 104
HOLLYWOOD FL
33021-8291
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-7700
  • Fax:
Mailing address:
  • Phone: 305-836-1090
  • Fax: 305-836-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW KOBINA HASFORD
Title or Position: MGMR
Credential: MD
Phone: 305-836-1090