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General NPI Number Information
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NPI Number | 1720406440
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Entity Type | Organization
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Legal Business Name | BOSTON MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 4901 N.W. 17TH WAY SUITE 202
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309
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Country | US
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Telephone | 954-229-1969
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Fax | 954-229-1994
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Provider Business Mailing Address
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Address Line | 4901 N.W. 17TH WAY SUITE 202
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309
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Country | US
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Telephone | 954-229-1969
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Fax | 954-229-1994
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. QUOC H. HA
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Credential |
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Telephone | 949-735-8451
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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 |
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License Number State |
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