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General NPI Number Information
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NPI Number | 1104150523
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Entity Type | Organization
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Legal Business Name | SARAH DODGE INC
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 10/02/2009
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Provider Practice Location Address
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Address Line | 8206 NW 103RD ST
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2202
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Country | US
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Telephone | 305-362-3162
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Fax | 305-362-3252
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Provider Business Mailing Address
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Address Line | 8206 NW 103RD ST
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2202
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Country | US
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Telephone | 305-362-3162
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Fax | 305-362-3252
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Authorized Official
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Title or Position | PRESIDENT
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Name | SARAH D MORRISON
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Credential | M.D.
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Telephone | 305-362-3162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME81343
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License Number State | FL
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