Provider Demographics
NPI:1437791688
Name:SOUTH FLORIDA SPINE AND ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA SPINE AND ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-829-1570
Mailing Address - Street 1:4515 WILES RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3414
Mailing Address - Country:US
Mailing Address - Phone:561-498-2000
Mailing Address - Fax:561-496-7074
Practice Address - Street 1:4515 WILES RD STE 201
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3414
Practice Address - Country:US
Practice Address - Phone:954-500-4554
Practice Address - Fax:954-400-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty