Healthcare Provider Details

I. General information

NPI: 1396296018
Provider Name (Legal Business Name): SOUTHEASTERN ORTHOPAEDIC SURGEONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD #830
MIAMI BEACH FL
33140-4556
US

IV. Provider business mailing address

4308 ALTON RD #830
MIAMI BEACH FL
33140-4556
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-0065
  • Fax:
Mailing address:
  • Phone: 305-532-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN HYDE
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 305-532-0065