Provider Demographics
NPI:1346777943
Name:MULTI-SPECIALTY MEDICAL CONSULTANTS PLLC
Entity Type:Organization
Organization Name:MULTI-SPECIALTY MEDICAL CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER/PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, PA
Authorized Official - Phone:754-205-6873
Mailing Address - Street 1:801 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3336
Mailing Address - Country:US
Mailing Address - Phone:754-226-7576
Mailing Address - Fax:754-205-6858
Practice Address - Street 1:801 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3336
Practice Address - Country:US
Practice Address - Phone:754-226-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty