Healthcare Provider Details

I. General information

NPI: 1386671857
Provider Name (Legal Business Name): COLORECTAL AND GI SPECIALISTS OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SW 12TH AVE STE 201
POMPANO BEACH FL
33069-3298
US

IV. Provider business mailing address

150 SW 12TH AVE STE 201
POMPANO BEACH FL
33069-3298
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-5530
  • Fax:
Mailing address:
  • Phone: 954-785-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN W. BEEBE
Title or Position: PRESIDENT
Credential:
Phone: 954-785-5530