Provider Demographics
NPI:1790957215
Name:R. G. STRATT, MD, PA
Entity Type:Organization
Organization Name:R. G. STRATT, MD, PA
Other - Org Name:BODYCARE CENTER FOR ADVANCED REJUVENATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:STRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-765-1316
Mailing Address - Street 1:100 N FEDERAL HWY
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1129
Mailing Address - Country:US
Mailing Address - Phone:954-765-1316
Mailing Address - Fax:954-765-1461
Practice Address - Street 1:100 N FEDERAL HWY
Practice Address - Street 2:SUITE C-2
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1129
Practice Address - Country:US
Practice Address - Phone:954-765-1316
Practice Address - Fax:954-765-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL408200261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG31763Medicare UPIN