Healthcare Provider Details

I. General information

NPI: 1346479664
Provider Name (Legal Business Name): FORT LAUDERDALE WOMENS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W OAKLAND PARK BLVD
OAKLAND PARK FL
33311-1521
US

IV. Provider business mailing address

2001 W OAKLAND PARK BLVD
OAKLAND PARK FL
33311-1521
US

V. Phone/Fax

Practice location:
  • Phone: 954-733-0121
  • Fax: 954-733-3870
Mailing address:
  • Phone: 954-733-0121
  • Fax: 954-733-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES S PENDERGRAFT IV
Title or Position: MANAGER
Credential: MD
Phone: 954-733-0121