MEDICARE: UNIVERSITY PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	OS7334	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568782464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	7495 NORTH UNIVERSITY DR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321
Country	:	US
Telephone Number	:	954-722-2302
Fax Number	:	954-428-4909

Provider Business Practice Location Address
First Line	:	7495 NORTH UNIVERSITY DR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321
Country	:	US
Telephone Number	:	954-722-2302
Fax Number	:	954-428-4909

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID R RODRIGUEZ
Credential	:
Telephone Number	:	786-417-2722

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	02/17/2012

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