Provider Demographics
NPI:1851665525
Name:PHYSICIANS AT HOME
Entity Type:Organization
Organization Name:PHYSICIANS AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-400-8617
Mailing Address - Street 1:3600 S STATE ROAD 7
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5200
Mailing Address - Country:US
Mailing Address - Phone:754-400-8617
Mailing Address - Fax:754-400-8620
Practice Address - Street 1:3600 S STATE ROAD 7
Practice Address - Street 2:SUITE 15
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5200
Practice Address - Country:US
Practice Address - Phone:754-400-8617
Practice Address - Fax:754-400-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty