Provider Demographics
NPI:1407372840
Name:PREMIER OBGYN OF SOUTH FLORIDA PLLC
Entity Type:Organization
Organization Name:PREMIER OBGYN OF SOUTH FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-698-5300
Mailing Address - Street 1:8145 NW 155TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5872
Mailing Address - Country:US
Mailing Address - Phone:305-698-5300
Mailing Address - Fax:
Practice Address - Street 1:8145 NW 155TH ST STE B
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5872
Practice Address - Country:US
Practice Address - Phone:305-698-5300
Practice Address - Fax:305-698-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000165000Medicaid