Healthcare Provider Details

I. General information

NPI: 1174299333
Provider Name (Legal Business Name): BIOFOURMIS CARE FL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1857 WELLS RD STE 209B
ORANGE PARK FL
32073-2340
US

IV. Provider business mailing address

333 SE 2ND AVE STE 2000
MIAMI FL
33131-2185
US

V. Phone/Fax

Practice location:
  • Phone: 310-626-1049
  • Fax:
Mailing address:
  • Phone: 310-626-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DEVION SMITH
Title or Position: DIRECTOR, PAYER CONTRACTING
Credential:
Phone: 424-326-8711