Provider Demographics
NPI:1538130281
Name:STRATT, R. G. (MD, PA)
Entity Type:Individual
Prefix:
First Name:R. G.
Middle Name:
Last Name:STRATT
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N FEDERAL HWY
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1129
Mailing Address - Country:US
Mailing Address - Phone:954-765-1316
Mailing Address - Fax:954-765-1461
Practice Address - Street 1:100 N FEDERAL HWY
Practice Address - Street 2:SUITE C-2
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1129
Practice Address - Country:US
Practice Address - Phone:954-765-1316
Practice Address - Fax:954-765-1461
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1538130281OtherNPI
FLG31763Medicare UPIN