Provider Demographics
NPI:1720086457
Name:CORAL SPRINGS PHYSICIAN ASSOCIATES INC
Entity Type:Organization
Organization Name:CORAL SPRINGS PHYSICIAN ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOFSHEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-344-4343
Mailing Address - Street 1:2041 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6132
Mailing Address - Country:US
Mailing Address - Phone:954-344-4343
Mailing Address - Fax:954-341-9411
Practice Address - Street 1:2041 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6132
Practice Address - Country:US
Practice Address - Phone:954-344-4343
Practice Address - Fax:954-341-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40414Medicare PIN