Healthcare Provider Details

I. General information

NPI: 1053342550
Provider Name (Legal Business Name): PAUL BRENDEN TARTELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 82ND AVE SUITE 104
PLANTATION FL
33324-7809
US

IV. Provider business mailing address

100 NW 82ND AVE SUITE# 104
PLANTATION FL
33324-7809
US

V. Phone/Fax

Practice location:
  • Phone: 954-236-0200
  • Fax: 954-474-3405
Mailing address:
  • Phone: 954-236-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberME62877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: