Provider Demographics
NPI:1710143987
Name:BROWARD HEAD NECK AND FACIAL PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:BROWARD HEAD NECK AND FACIAL PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GUILDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-937-7027
Mailing Address - Street 1:2671 RIVIERA MNR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3422
Mailing Address - Country:US
Mailing Address - Phone:954-384-2340
Mailing Address - Fax:954-384-2341
Practice Address - Street 1:2671 RIVIERA MNR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-3422
Practice Address - Country:US
Practice Address - Phone:954-384-2340
Practice Address - Fax:954-384-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59574207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12164Medicare UPIN