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General NPI Number Information
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NPI Number | 1598875486
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Entity Type | Organization
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Legal Business Name | BARRY C PEVNER MD PA
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 601 N FLAMINGO RD SUITE 303
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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 | 954-557-5407
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Fax | 954-436-8024
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Provider Business Mailing Address
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Address Line | 601 N FLAMINGO RD SUITE 303
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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 | 954-347-1360
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Fax | 954-436-8024
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY C PEVNER
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Credential | MD
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Telephone | 954-347-1360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME50444
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License Number State | FL
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