Healthcare Provider Details

I. General information

NPI: 1023480985
Provider Name (Legal Business Name): FIDEL S. GOLDSON, DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 N STATE ROAD 7
PLANTATION FL
33317-2129
US

IV. Provider business mailing address

734 N STATE ROAD 7
PLANTATION FL
33317-2129
US

V. Phone/Fax

Practice location:
  • Phone: 954-584-3774
  • Fax: 954-583-0497
Mailing address:
  • Phone: 954-584-3774
  • Fax: 954-583-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberPT19489
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberCH9276
License Number StateFL

VIII. Authorized Official

Name: DR. FIDEL GOLDSON
Title or Position: PRESIDENT
Credential: DC, PT
Phone: 954-584-3774