Provider Demographics
NPI:1881023166
Name:ASSOCIATESMD
Entity Type:Organization
Organization Name:ASSOCIATESMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-279-2572
Mailing Address - Street 1:4801 S UNIVERSITY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3835
Mailing Address - Country:US
Mailing Address - Phone:954-279-2572
Mailing Address - Fax:855-299-5905
Practice Address - Street 1:4801 S UNIVERSITY DR STE 104
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3835
Practice Address - Country:US
Practice Address - Phone:954-279-2572
Practice Address - Fax:855-299-5905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATES IN FAMILY PRACTICE OF BROWARD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty