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General NPI Number Information
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NPI Number | 1851665525
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Entity Type | Organization
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Legal Business Name | PHYSICIANS AT HOME
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Dates
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Enumeration Date | 02/28/2012
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 3600 S STATE ROAD 7 SUITE 15
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City | MIRAMAR
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State | FL
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Zip | 33023-5200
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Country | US
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Telephone | 754-400-8617
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Fax | 754-400-8620
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Provider Business Mailing Address
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Address Line | 3600 S STATE ROAD 7 SUITE 14
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City | MIRAMAR
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State | FL
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Zip | 33023-5200
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Country | US
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Telephone | 754-400-8617
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Fax | 754-400-8620
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. ALEX BARROSO
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Credential |
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Telephone | 754-400-8617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME47936
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License Number State | FL
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