Provider Demographics
NPI:1861483158
Name:JOHN C NORDT III MD & ASSOC PA
Entity Type:Organization
Organization Name:JOHN C NORDT III MD & ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NORDT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:305-662-2851
Mailing Address - Street 1:4720 LEJEUNE ROAD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-662-2851
Mailing Address - Fax:305-662-2532
Practice Address - Street 1:4720 LEJEUNE RD.
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146
Practice Address - Country:US
Practice Address - Phone:305-662-2851
Practice Address - Fax:305-662-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 34439207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95231Medicare ID - Type Unspecified
FLD63373Medicare UPIN