Healthcare Provider Details

I. General information

NPI: 1629272828
Provider Name (Legal Business Name): PEDIATRIC PULMONOLOGY GROUP OF SOUTH FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT SUITE 203
MIAMI FL
33155-4000
US

IV. Provider business mailing address

3200 SW 60TH CT SUITE 203
MIAMI FL
33155-4000
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8380
  • Fax: 305-663-8417
Mailing address:
  • Phone: 305-662-8380
  • Fax: 305-663-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOISES SIMPSER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-662-8380