Healthcare Provider Details

I. General information

NPI: 1386939577
Provider Name (Legal Business Name): SOUTH FLORIDA ENDOCRINOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 NW 179TH AVE SUITE 102
PEMBROKE PINES FL
33029-2818
US

IV. Provider business mailing address

2905 N COMMERCE PKWY
MIRAMAR FL
33025-3957
US

V. Phone/Fax

Practice location:
  • Phone: 954-967-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN POLNER
Title or Position: PRESIDENT
Credential: MD
Phone: 954-967-6550