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General NPI Number Information
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NPI Number | 1235499179
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Entity Type | Organization
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Legal Business Name | PINES CARDIOLOGY INC
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 10071 PINES BLVD BLDG B SUITE A
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City | PEMBROKE PINES
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-205-3494
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Fax |
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Provider Business Mailing Address
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Address Line | 10071 PINES BLVD BLDG B SUITE A
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City | PEMBROKE PINES
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-205-3494
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROY L WHITTINGHAM
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Credential | MD.
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Telephone | 954-205-3494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME70512
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License Number State | FL
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