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General NPI Number Information
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NPI Number | 1437791688
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA SPINE AND ORTHOPEDICS, LLC
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 4515 WILES RD STE 201
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3414
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Country | US
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Telephone | 954-500-4554
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Fax | 954-400-0904
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Provider Business Mailing Address
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Address Line | 4515 WILES RD STE 201
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3414
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Country | US
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Telephone | 561-498-2000
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Fax | 561-496-7074
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Authorized Official
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Title or Position | DO/AUTHORIZED OFFICIAL
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Name | JOHN PATRICK MALLOY IV
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Credential |
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Telephone | 954-500-4554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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