Healthcare Provider Details

I. General information

NPI: 1821022989
Provider Name (Legal Business Name): JASON FROST D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FLAMINGO RD STE 319
PEMBROKE PINES FL
33028-1011
US

IV. Provider business mailing address

601 N FLAMINGO RD STE 319
PEMBROKE PINES FL
33028-1011
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-8786
  • Fax: 954-442-3767
Mailing address:
  • Phone: 954-442-8786
  • Fax: 954-442-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS5557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: