Provider Demographics
NPI:1508195512
Name:FLORIDA TELERAD LLC
Entity Type:Organization
Organization Name:FLORIDA TELERAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-712-2000
Mailing Address - Street 1:13737 NOEL RD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1331
Mailing Address - Country:US
Mailing Address - Phone:214-712-2074
Mailing Address - Fax:214-712-2487
Practice Address - Street 1:2840 PADDOCK RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3015
Practice Address - Country:US
Practice Address - Phone:954-205-7206
Practice Address - Fax:214-712-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty