Provider Demographics
NPI:1922153287
Name:DEERFIELD MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:DEERFIELD MEDICAL GROUP LLC
Other - Org Name:SUSSMAN MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-428-4800
Mailing Address - Street 1:1979 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1444
Mailing Address - Country:US
Mailing Address - Phone:954-428-4800
Mailing Address - Fax:954-428-4909
Practice Address - Street 1:1979 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1444
Practice Address - Country:US
Practice Address - Phone:954-428-4800
Practice Address - Fax:954-428-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7879207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDING NUMBERMedicare ID - Type UnspecifiedCLINIC AND LABORATORY
FLAJ003Medicare PIN