Provider Demographics
NPI:1265601587
Name:ENT SOUTH FLORIDA INC
Entity type:Organization
Organization Name:ENT SOUTH FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:CALLARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-760-7836
Mailing Address - Street 1:1625 SE 3RD AVE
Mailing Address - Street 2:SUITE 717
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2521
Mailing Address - Country:US
Mailing Address - Phone:954-760-7836
Mailing Address - Fax:954-760-7869
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:SUITE 717
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-760-7836
Practice Address - Fax:954-760-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56677207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty