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NPI Code Detail

MEDICARE: DEERFIELD MEDICAL GROUP LLC

MEDICARE: DEERFIELD MEDICAL GROUP 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
1207Q00000XFamily Medicine PhysicianHCC7879FL
2207R00000XInternal Medicine PhysicianHCC7879FL

General Provider Information

NPI Number : 1922153287
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEERFIELD MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 1979 W HILLSBORO BLVD
Second Line : SUITE 1
City : DEERFIELD BEACH
State : FL
Zip : 33442-1444
Country : US
Telephone Number : 954-428-4800
Fax Number : 954-428-4909
Provider Business Practice Location Address
First Line : 1979 W HILLSBORO BLVD
Second Line : SUITE 1
City : DEERFIELD BEACH
State : FL
Zip : 33442-1444
Country : US
Telephone Number : 954-428-4800
Fax Number : 954-428-4909
Authorized Official
Title or Position : PRESIDENT
Name : DAVID R RODRIGUEZ
Credential :
Telephone Number : 954-428-4800
Provider Enumeration Date : 01/24/2007
Last Update Date : 06/24/2008

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Practice Location Address:
1979 W HILLSBORO BLVD , SUITE 1
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1659566545 — MS. CONNIE X. LIU M.D.,
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1629245121 — MRS. CAREY ANNE CONNOLLY D.O.
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1376710541 — MRS. FELICIA D KENNICOTT PA-C
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Practice Fax: 888-498-4773

Directions to “DEERFIELD MEDICAL GROUP LLC ” Practice Location

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