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General NPI Number Information
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NPI Number | 1497122519
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Entity Type | Organization
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Legal Business Name | SOUTHEAST FLORIDA UROLOGY LLC
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 500 N HIATUS RD SUITE 107
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5213
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Country | US
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Telephone | 954-392-6606
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Fax | 954-392-6169
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Provider Business Mailing Address
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Address Line | 500 N HIATUS RD SUITE 107
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5213
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Country | US
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Telephone | 954-392-6606
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Fax | 954-392-6169
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Authorized Official
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Title or Position | CEO
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Name | ROBERT SHERMAN
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Credential | MD
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Telephone | 954-392-6606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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