Provider Demographics
NPI:1578964524
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:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:K
Authorized Official - Last Name:HASFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-610-6069
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 1:3700 WASHINGTON ST STE 104
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8291
Practice Address - Country:US
Practice Address - Phone:305-836-1090
Practice Address - Fax:305-836-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101466208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100684900Medicaid