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General NPI Number Information
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NPI Number | 1508921818
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Entity Type | Organization
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Legal Business Name | SOUTHEAST GYNECOLOGICAL SPECIALTY PA
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 2964 N STATE ROAD 7 SUITE 100
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City | MARGATE
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State | FL
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Zip | 33063-5755
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Country | US
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Telephone | 954-974-5190
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Fax | 954-974-0743
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Provider Business Mailing Address
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Address Line | 2964 N STATE ROAD 7 SUITE 100
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City | MARGATE
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State | FL
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Zip | 33063-5755
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Country | US
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Telephone | 954-974-5190
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Fax | 954-974-0743
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Authorized Official
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Title or Position | MCC
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Name | LAURA B BURKE
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Credential |
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Telephone | 954-974-5190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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