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General NPI Number Information
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NPI Number | 1194129759
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Entity Type | Organization
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Legal Business Name | PREMIERMD MSO,LLC
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3465 GALT OCEAN DR SUITE#203
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-7077
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Country | US
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Telephone | 954-561-5135
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Fax |
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Provider Business Mailing Address
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Address Line | 3465 GALT OCEAN DR SUITE#203
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-7077
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Country | US
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Telephone | 954-561-5135
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. VICTOR TOLEDANO
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Credential | M.D.
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Telephone | 954-566-7717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | FL
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