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General NPI Number Information
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NPI Number | 1700973971
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CARE OF POMPANO, LLC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 SE 19TH STREET
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City | POMPANO BEACH
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State | FL
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Zip | 33060
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Country | US
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Telephone | 954-943-7638
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32211-8768
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Country | US
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Telephone | 904-805-1300
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Fax | 904-805-1456
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | STEVEN SCOTT
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Credential | MD
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Telephone | 904-805-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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