Healthcare Provider Details

I. General information

NPI: 1972585651
Provider Name (Legal Business Name): SURGERY SPECIALISTS OF BROWARD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 N UNIVERSITY DR SUITE 205
TAMARAC FL
33321-2977
US

IV. Provider business mailing address

PO BOX 451986
SUNRISE FL
33345-1986
US

V. Phone/Fax

Practice location:
  • Phone: 954-476-9899
  • Fax: 954-476-9180
Mailing address:
  • Phone: 954-838-2371
  • 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: DR. LEWIS GOLD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-838-2371