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General NPI Number Information
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NPI Number | 1992984652
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Entity Type | Organization
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Legal Business Name | BROWARD FAMILY MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 2701 NE 14TH STREET CSWY SUITE 5
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3535
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Country | US
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Telephone | 954-545-1560
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Fax | 954-545-1560
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Provider Business Mailing Address
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Address Line | 2701 NE 14TH STREET CSWY SUITE 5
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3535
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Country | US
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Telephone | 954-545-1560
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Fax | 954-545-1560
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Authorized Official
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Title or Position | OWNER
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Name | GLEN A WASKIN
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Credential | DO
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Telephone | 954-545-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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