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General NPI Number Information
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NPI Number | 1932943479
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Entity Type | Organization
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Legal Business Name | FAU BROWARD HEALTH ACADEMIC PRACTICE PLAN INC
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 6405 N FEDERAL HWY STE 404
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-1414
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Country | US
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Telephone | 954-958-7195
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Fax | 954-958-7115
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Provider Business Mailing Address
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Address Line | 2100 E SAMPLE RD STE 101
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-7574
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Country | US
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Telephone | 954-958-7195
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Fax | 954-958-7115
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Authorized Official
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Title or Position | PHYSICIAN/CEO
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Name | DR. JERRY CAPOTE
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Credential | MD
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Telephone | 954-786-6449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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