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General NPI Number Information
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NPI Number | 1588775068
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA UROLOGY CENTER INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 601 N FLAMINGO RD STE 308
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1010
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Country | US
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Telephone | 954-392-7770
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Fax | 954-392-7577
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Provider Business Mailing Address
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Address Line | 601 N FLAMINGO RD STE 308
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1010
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Country | US
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Telephone | 954-392-7770
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Fax | 954-392-7577
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Authorized Official
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Title or Position | OWNER
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Name | MAURY A JAYSON
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Credential | MD
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Telephone | 954-392-7770
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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 | ME84787
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License Number State | FL
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