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General NPI Number Information
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NPI Number | 1083664346
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA BAPTIST GROUP
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18331 PINES BLVD SUITE 308
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City | PEMBROKE PINES
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-636-0094
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Fax |
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Provider Business Mailing Address
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Address Line | 18331 PINES BLVD SUITE 308
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City | PEMBROKE PINES
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-636-0094
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALBERT THAUREAUX
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Credential |
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Telephone | 954-636-0094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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