Healthcare Provider Details

I. General information

NPI: 1659323632
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES PA OF FORT LAUDERDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 N UNIVERSITY DR
TAMARAC FL
33321-2913
US

IV. Provider business mailing address

PO BOX 93
LANDISVILLE PA
17538-0093
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-2200
  • Fax:
Mailing address:
  • Phone: 800-800-1617
  • Fax: 866-759-5426

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. GASTON MENDEZ JR.
Title or Position: PRES
Credential: MD
Phone: 954-721-2200