Healthcare Provider Details

I. General information

NPI: 1689638728
Provider Name (Legal Business Name): PAUL HENRI TELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 W BROWARD BLVD
PLANTATION FL
33317-3753
US

IV. Provider business mailing address

5151 SW 21ST CT
PLANTATION FL
33317-6053
US

V. Phone/Fax

Practice location:
  • Phone: 954-791-9580
  • Fax: 954-797-0473
Mailing address:
  • Phone: 954-791-9580
  • Fax: 954-797-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number31939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: