Provider Demographics
NPI:1003133489
Name:BROWARD PODIATRY ASSOCIATES, PA
Entity Type:Organization
Organization Name:BROWARD PODIATRY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-987-0550
Mailing Address - Street 1:3816 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6750
Mailing Address - Country:US
Mailing Address - Phone:954-987-0550
Mailing Address - Fax:954-987-0553
Practice Address - Street 1:3816 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6750
Practice Address - Country:US
Practice Address - Phone:954-987-0550
Practice Address - Fax:954-987-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1504213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340172300Medicaid
87837Medicare PIN
FL340172300Medicaid
FL6261900001Medicare NSC