Provider Demographics
NPI:1922012087
Name:CARDIOVASCULAR SPECIALISTS OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-382-1550
Mailing Address - Street 1:10650 W STATE ROAD 84
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4235
Mailing Address - Country:US
Mailing Address - Phone:954-382-1550
Mailing Address - Fax:954-382-1250
Practice Address - Street 1:10650 W STATE ROAD 84
Practice Address - Street 2:SUITE 104
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4235
Practice Address - Country:US
Practice Address - Phone:954-382-1550
Practice Address - Fax:954-382-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269718100Medicaid
FL269718100Medicaid