Provider Demographics
NPI:1518383470
Name:BROWARD DERMATOLOGY LLC
Entity Type:Organization
Organization Name:BROWARD DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHIFENG
Authorized Official - Middle Name:
Authorized Official - Last Name:HUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-362-4106
Mailing Address - Street 1:16766 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4917
Mailing Address - Country:US
Mailing Address - Phone:954-235-5361
Mailing Address - Fax:954-623-4106
Practice Address - Street 1:14932 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1213
Practice Address - Country:US
Practice Address - Phone:954-235-5361
Practice Address - Fax:954-236-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115609207N00000X
FLME80400207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336272608Other1336272608, NPI
FL1376779371Medicare UPIN