MEDICARE: SOUTH FLORIDA PREMIER SURGERY 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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1912765835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA PREMIER SURGERY LLC

Provider Business Mailing Address
First Line	:	PO BOX 7415
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33482-7415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 LINTON BLVD STE 10A
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6501
Country	:	US
Telephone Number	:	305-761-7610
Fax Number	:

Authorized Official
Title or Position	:	CO OWNER
Name	:	JOSHUA SIMON
Credential	:	DO
Telephone Number	:	352-215-3989

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	05/25/2026

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