Provider Demographics
NPI:1851404834
Name:VALENT, PHILLIP S
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:S
Last Name:VALENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2040
Mailing Address - Country:US
Mailing Address - Phone:954-463-4383
Mailing Address - Fax:954-463-9820
Practice Address - Street 1:1309 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2040
Practice Address - Country:US
Practice Address - Phone:954-463-4383
Practice Address - Fax:954-463-9820
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269400000Medicaid
FL37786ZMedicare ID - Type Unspecified
FLI09977Medicare UPIN