Healthcare Provider Details

I. General information

NPI: 1962891838
Provider Name (Legal Business Name): GLOBAL TRAUMA SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 SE MIRA LAVELLA
PORT SAINT LUCIE FL
34984-6615
US

IV. Provider business mailing address

126 SE MIRA LAVELLA
PORT SAINT LUCIE FL
34984-6615
US

V. Phone/Fax

Practice location:
  • Phone: 772-233-6166
  • Fax: 772-345-4442
Mailing address:
  • Phone: 772-233-6166
  • Fax: 772-345-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME65570
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME65570
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME65570
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME65570
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME65570
License Number StateFL

VIII. Authorized Official

Name: DR. SLOBODAN JAZAREVIC
Title or Position: C.E.O.
Credential: M.D.
Phone: 772-233-6166