Provider Demographics
NPI:1164473120
Name:ENT AND ALLERGY ASSOCIATES OF FLORIDA, LLC
Entity Type:Organization
Organization Name:ENT AND ALLERGY ASSOCIATES OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CBO CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:LIBUSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-338-3267
Mailing Address - Street 1:900 NW 13TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2350
Mailing Address - Country:US
Mailing Address - Phone:561-391-3333
Mailing Address - Fax:561-391-5618
Practice Address - Street 1:6421 CONGRESS AVE STE 113
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2858
Practice Address - Country:US
Practice Address - Phone:561-338-3267
Practice Address - Fax:561-391-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21513OtherBLUE CROSS FLORIDA GROUP
FL253536000Medicaid
FL253536000Medicaid