Provider Demographics
NPI:1083664346
Name:SOUTH FLORIDA BAPTIST GROUP
Entity Type:Organization
Organization Name:SOUTH FLORIDA BAPTIST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THAUREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-636-0094
Mailing Address - Street 1:18331 PINES BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-636-0094
Mailing Address - Fax:
Practice Address - Street 1:18331 PINES BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-636-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9765Medicare ID - Type Unspecified