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General NPI Number Information
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NPI Number | 1699217281
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Entity Type | Organization
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Legal Business Name | PRESTIGE PHYSICIANS LLC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 4701 N FEDERAL HWY STE A21
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4608
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Country | US
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Telephone | 954-770-0611
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Fax | 954-491-3930
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Provider Business Mailing Address
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Address Line | 4701 N FEDERAL HWY STE A21
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4608
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Country | US
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Telephone | 954-770-0611
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Fax | 954-491-3930
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIRA FENTON
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Credential | DO
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Telephone | 954-771-0611
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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 | OS11264
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS11016
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License Number State | FL
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