Provider Demographics
NPI:1396158630
Name:FLORIDA DOCTORS GROUP, CORP.
Entity type:Organization
Organization Name:FLORIDA DOCTORS GROUP, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-302-7070
Mailing Address - Street 1:2100 PONCE DE LEON BLVD STE 1240
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5215
Mailing Address - Country:US
Mailing Address - Phone:786-471-3535
Mailing Address - Fax:305-508-6615
Practice Address - Street 1:2100 PONCE DE LEON BLVD STE 1240
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5215
Practice Address - Country:US
Practice Address - Phone:786-471-3535
Practice Address - Fax:305-508-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management