Provider Demographics
NPI:1730634643
Name:SOUTH FLORIDA SPINE & SPORTS SPECIALISTS LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA SPINE & SPORTS SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-551-6921
Mailing Address - Street 1:3000 SW 148TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4181
Mailing Address - Country:US
Mailing Address - Phone:954-551-6921
Mailing Address - Fax:
Practice Address - Street 1:3000 SW 148TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4181
Practice Address - Country:US
Practice Address - Phone:954-551-6921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9439208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty