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NPI Code Detail

MEDICARE: ORTHO FLORIDA, LLC

MEDICARE: ORTHO FLORIDA, 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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number : 1770254385
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHO FLORIDA, LLC
Provider Business Mailing Address
First Line : 433 PLAZA REAL STE 275
Second Line :
City : BOCA RATON
State : FL
Zip : 33432-3999
Country : US
Telephone Number : 561-300-1792
Fax Number :
Provider Business Practice Location Address
First Line : 3333 W COMMERCIAL BLVD STE 101
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-3424
Country : US
Telephone Number : 954-751-6990
Fax Number :
Authorized Official
Title or Position : CEO
Name : DANE TRASK
Credential :
Telephone Number : 813-747-1128
Provider Enumeration Date : 09/23/2021
Last Update Date : 09/23/2021

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Directions to “ORTHO FLORIDA, LLC ” Practice Location

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