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General NPI Number Information
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NPI Number | 1487624771
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE ASSOCIATES OF SOUTH FLORIDA, P.A.
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 220 SW 84TH AVE STE 102
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City | PLANTATION
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State | FL
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Zip | 33324-2729
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Country | US
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Telephone | 954-720-1530
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Fax | 954-720-6540
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Provider Business Mailing Address
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Address Line | 220 SW 84TH AVE STE 102
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City | PLANTATION
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State | FL
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Zip | 33324-2729
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Country | US
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Telephone | 954-349-2345
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Fax | 954-641-1086
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CHRYSTAL A. HERRERA
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Credential |
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Telephone | 305-218-6965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery 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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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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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