MEDICARE: BROWARD PHYSICIAN CLINIC

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	174400000X	Specialist	HCCR2445	FL

General Provider Information

NPI Number	:	1609811298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD PHYSICIAN CLINIC

Provider Business Mailing Address
First Line	:	732 S FEDERAL HWY
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-4314
Country	:	US
Telephone Number	:	954-923-6070
Fax Number	:	954-923-6747

Provider Business Practice Location Address
First Line	:	732 S FEDERAL HWY
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-4314
Country	:	US
Telephone Number	:	954-923-6070
Fax Number	:	954-923-6747

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSCAR QUINTERO
Credential	:
Telephone Number	:	954-923-6070

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	10/07/2008

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