Healthcare Provider Details

I. General information

NPI: 1508937632
Provider Name (Legal Business Name): STRATTON STERGHOS SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

201 NW 82ND AVE SUITE 104
PLANTATION FL
33324-7808
US

IV. Provider business mailing address

201 NW 82ND AVE SUITE 104
PLANTATION FL
33324-7808
US

V. Phone/Fax

Practice location:
  • Phone: 954-472-2201
  • Fax: 954-423-3850
Mailing address:
  • Phone: 954-472-2201
  • Fax: 954-423-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME11350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: