Healthcare Provider Details

I. General information

NPI: 1124062542
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

PO BOX 918757
ORLANDO FL
32891-8757
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8957
  • Fax: 305-585-5259
Mailing address:
  • Phone: 305-585-8957
  • Fax: 305-585-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3998
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3998
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3998
License Number StateFL

VIII. Authorized Official

Name: MR. FRANK J. BARRETT
Title or Position: EXEC. VP, CHIEF FINANCIAL OFFICER
Credential:
Phone: 305-585-7137