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General NPI Number Information
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NPI Number | 1356568307
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Entity Type | Organization
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Legal Business Name | ENT ASSOCIATES OF SOUTH FLORIDA LLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 2101 RIVERSIDE DR SUITE 105
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-6260
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Country | US
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Telephone | 954-345-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 9311 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4101
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Country | US
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Telephone | 954-755-8885
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SHAWN PETER SABGA
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Credential |
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Telephone | 954-755-8885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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