Provider Demographics
NPI:1437568847
Name:HUA E. FANG-PATRICK MD
Entity Type:Organization
Organization Name:HUA E. FANG-PATRICK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HUA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FANG-PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-499-0572
Mailing Address - Street 1:1951 SW 172ND AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5614
Mailing Address - Country:US
Mailing Address - Phone:954-499-0572
Mailing Address - Fax:954-499-3523
Practice Address - Street 1:1951 SW 172ND AVE STE 410
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5614
Practice Address - Country:US
Practice Address - Phone:954-499-0572
Practice Address - Fax:954-499-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252123700Medicaid