Provider Demographics
NPI:1770676561
Name:SOUTH FLORIDA MEDICAL GROUP
Entity Type:Organization
Organization Name:SOUTH FLORIDA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-446-0330
Mailing Address - Street 1:2695 S LE JEUNE RD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5839
Mailing Address - Country:US
Mailing Address - Phone:305-446-0330
Mailing Address - Fax:305-446-2841
Practice Address - Street 1:2695 S LE JEUNE RD
Practice Address - Street 2:SUITE #300
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5839
Practice Address - Country:US
Practice Address - Phone:305-446-0330
Practice Address - Fax:305-446-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33985Medicare ID - Type UnspecifiedMRDICARE PROVIDER NUMBER