=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669757472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSET PEDIATRICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2011
-----------------------------------------------------
Last Update Date | 10/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7300 SW 62ND PL PENTHOUSE-WEST
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-661-1962
-----------------------------------------------------
Fax | 305-661-6112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7300 SW 62ND PL PENTHOUSE-WEST
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-661-1962
-----------------------------------------------------
Fax | 305-661-6112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. PHILIP DUNCAN FLOYD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-661-1962
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 83179
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------