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General NPI Number Information
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NPI Number | 1194303487
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF REGENERATIVE ORTHOPEDICS AND SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 3333 W COMMERCIAL BLVD STE 101
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3424
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Country | US
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Telephone | 786-566-0338
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 NE 54TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-4932
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JORGE ANTONIO GONZALEZ
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Credential | MD
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Telephone | 786-566-0338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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