Provider Demographics
NPI:1558534867
Name:JOSEPH T HORGAN MD PA
Entity Type:Organization
Organization Name:JOSEPH T HORGAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-438-9800
Mailing Address - Street 1:603 N FLAMINGO RD
Mailing Address - Street 2:358
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-438-9800
Mailing Address - Fax:954-438-7544
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:358
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-438-9800
Practice Address - Fax:954-438-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40264261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64665Medicare UPIN