Healthcare Provider Details

I. General information

NPI: 1124382940
Provider Name (Legal Business Name): JAN PAVLINEC M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 SE 22ND AVE
POMPANO BEACH FL
33062-7045
US

IV. Provider business mailing address

1161 SE 22ND AVE
POMPANO BEACH FL
33062-7045
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-7343
  • Fax: 954-785-4636
Mailing address:
  • Phone: 954-785-7343
  • Fax: 954-785-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMEO38469
License Number StateFL

VIII. Authorized Official

Name: DR. JAN PAVLINEC
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-801-2398