Healthcare Provider Details

I. General information

NPI: 1750968152
Provider Name (Legal Business Name): LAWRENCE BRUNDIDGE II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 W BROWARD BLVD
PLANTATION FL
33324-2701
US

IV. Provider business mailing address

601 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-4802
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-6600
  • Fax: 727-819-2928
Mailing address:
  • Phone: 407-303-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME170207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: