Provider Demographics
NPI:1629766712
Name:G CLEF MRI PLUS LLC
Entity Type:Organization
Organization Name:G CLEF MRI PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOODY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBREUZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-533-4846
Mailing Address - Street 1:2453 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3723
Mailing Address - Country:US
Mailing Address - Phone:954-533-4846
Mailing Address - Fax:
Practice Address - Street 1:2453 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3723
Practice Address - Country:US
Practice Address - Phone:954-533-4846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty