Healthcare Provider Details

I. General information

NPI: 1144473323
Provider Name (Legal Business Name): ELLIOT M WORTZEL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NW 82ND AVE #305
PLANTATION FL
33324-7808
US

IV. Provider business mailing address

201 NW 82ND AVE #305
PLANTATION FL
33324-7808
US

V. Phone/Fax

Practice location:
  • Phone: 954-370-1053
  • Fax:
Mailing address:
  • Phone: 954-370-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME22208
License Number StateFL

VIII. Authorized Official

Name: ELLIOT M WORTZEL
Title or Position: PRESIDENT
Credential: MD
Phone: 954-473-5304