Provider Demographics
NPI:1174682082
Name:SOUTH FLORIDA CENTER FOR GYNECOLOGIC ONCOLOGY P A
Entity Type:Organization
Organization Name:SOUTH FLORIDA CENTER FOR GYNECOLOGIC ONCOLOGY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:O
Authorized Official - Last Name:RECIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-997-8991
Mailing Address - Street 1:6200 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3230
Mailing Address - Country:US
Mailing Address - Phone:561-997-8991
Mailing Address - Fax:561-997-8927
Practice Address - Street 1:6200 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3230
Practice Address - Country:US
Practice Address - Phone:561-997-8991
Practice Address - Fax:561-997-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260563500Medicaid
FLK4680Medicare ID - Type Unspecified