Provider Demographics
NPI:1467118745
Name:UROLOGY PROFESSIONALS OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:UROLOGY PROFESSIONALS OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGMR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:KOBINA
Authorized Official - Last Name:HASFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-836-1090
Mailing Address - Street 1:3700 WASHINGTON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8291
Mailing Address - Country:US
Mailing Address - Phone:305-836-1090
Mailing Address - Fax:305-836-1199
Practice Address - Street 1:3939 HOLLYWOOD BLVD STE 3A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6736
Practice Address - Country:US
Practice Address - Phone:954-961-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY PROFESSIONALS OF SOUTH FLORIDA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty