Provider Demographics
NPI:1093723348
Name:DOCTORS HEALTH GROUP OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:DOCTORS HEALTH GROUP OF SOUTH FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BASTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-817-1010
Mailing Address - Street 1:3850 COCONUT CREEK PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1600
Mailing Address - Country:US
Mailing Address - Phone:954-973-9222
Mailing Address - Fax:954-973-7135
Practice Address - Street 1:3850 COCONUT CREEK PKWY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1600
Practice Address - Country:US
Practice Address - Phone:954-693-9133
Practice Address - Fax:954-641-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1323Medicare PIN