Healthcare Provider Details

I. General information

NPI: 1093126591
Provider Name (Legal Business Name): PLANTATION PAVILION OB-GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 W BROWARD BLVD STE C
PLANTATION FL
33317-3775
US

IV. Provider business mailing address

4330 W BROWARD BLVD STE C
PLANTATION FL
33317-3775
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-0351
  • Fax: 954-990-6464
Mailing address:
  • Phone: 954-587-0351
  • Fax: 954-990-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGES EDOUARD
Title or Position: OB-GYN
Credential: M.D.
Phone: 954-587-0351