Healthcare Provider Details

I. General information

NPI: 1982081527
Provider Name (Legal Business Name): ICE PULMONARY NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17180 ROYAL PALM BLVD STE 3
WESTON FL
33326-2394
US

IV. Provider business mailing address

17180 ROYAL PALM BLVD SUITE STE 3
WESTON FL
33326
US

V. Phone/Fax

Practice location:
  • Phone: 954-482-4747
  • Fax: 954-301-5939
Mailing address:
  • Phone: 954-482-4747
  • Fax: 954-301-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME104425
License Number StateFL

VIII. Authorized Official

Name: DR. GUSTAVO FERRER
Title or Position: PRESIDENT
Credential: MD
Phone: 954-482-4747