Healthcare Provider Details

I. General information

NPI: 1104217561
Provider Name (Legal Business Name): PELVIC HEALTH INSTITUTE AND MINIMALLY INVASIVE SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SAMPLE RD SUITE 105
POMPANO BEACH FL
33064-4443
US

IV. Provider business mailing address

601 E SAMPLE RD SUITE 105
POMPANO BEACH FL
33064-4443
US

V. Phone/Fax

Practice location:
  • Phone: 188-869-0317
  • Fax:
Mailing address:
  • Phone: 188-869-0317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME109151
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME109151
License Number StateFL

VIII. Authorized Official

Name: LEON PLOWRIGHT
Title or Position: OWNER
Credential: M.D.
Phone: 18886903171