Provider Demographics
NPI:1386689503
Name:LONNIE M EPSTEIN MD PA
Entity Type:Organization
Organization Name:LONNIE M EPSTEIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-1928
Mailing Address - Street 1:5601 N DIXIE HWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4148
Mailing Address - Country:US
Mailing Address - Phone:954-491-1928
Mailing Address - Fax:951-491-0367
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-491-1928
Practice Address - Fax:951-491-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30588208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty