Provider Demographics
NPI:1295498343
Name:PRODOCTORS MEDICAL PLLC
Entity type:Organization
Organization Name:PRODOCTORS MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DREHER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-605-4391
Mailing Address - Street 1:1915 NE 45TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5118
Mailing Address - Country:US
Mailing Address - Phone:305-286-6670
Mailing Address - Fax:
Practice Address - Street 1:1915 NE 45TH ST STE 106
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5118
Practice Address - Country:US
Practice Address - Phone:305-283-6670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3177832OtherMEDICAL LICENSE
FL17814600Medicaid
FLMD4327931OtherDEA