Healthcare Provider Details

I. General information

NPI: 1477670776
Provider Name (Legal Business Name): SOUTH FLORIDA PATHOLOGY LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 OVERSEAS HWY 209
MARATHON FL
33050-3600
US

IV. Provider business mailing address

PO BOX 17347
PLANTATION FL
33318-7347
US

V. Phone/Fax

Practice location:
  • Phone: 954-370-1053
  • Fax:
Mailing address:
  • Phone: 954-370-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateFL

VIII. Authorized Official

Name: ZHIMING LI
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 954-370-1053