Provider Demographics
NPI:1013195783
Name:SOUTH FLORIDA OBSTETRICAL AND GYNECOLOGICAL SERVICES PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA OBSTETRICAL AND GYNECOLOGICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALEXIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-452-4377
Mailing Address - Street 1:209 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2708
Mailing Address - Country:US
Mailing Address - Phone:954-452-4377
Mailing Address - Fax:954-452-1022
Practice Address - Street 1:209 SW 84TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2708
Practice Address - Country:US
Practice Address - Phone:954-452-4377
Practice Address - Fax:954-452-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36984207V00000X
FLME78854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2597Medicare PIN