=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326205642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORT LAUDERDALE ORTHOPAEDICS PL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 07/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1960 NE 47TH ST STE 102
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-463-3200
-----------------------------------------------------
Fax | 954-463-3292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1960 NE 47TH ST STE 102
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-7708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-463-3200
-----------------------------------------------------
Fax | 954-463-3292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MICHAEL J RUDDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-463-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number | ME44143
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | ME44143
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME44143
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------