Healthcare Provider Details

I. General information

NPI: 1548184823
Provider Name (Legal Business Name): BROADER MRI OF STUART, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 SW FEDERAL HIGHWAY
STUART FL
34994
US

IV. Provider business mailing address

13297 MAJESTIC WAY
COOPER CITY FL
33330-2657
US

V. Phone/Fax

Practice location:
  • Phone: 772-241-3224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE MODESTO IRIBAR
Title or Position: OWNER
Credential: DC
Phone: 954-529-1083