Provider Demographics
NPI:1780844803
Name:ENDOCRINOLOGY AND DIABETES ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ENDOCRINOLOGY AND DIABETES ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:PERCIVAL
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-575-4040
Mailing Address - Street 1:1801 N UNIVERSITY DR
Mailing Address - Street 2:SUITE209
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8920
Mailing Address - Country:US
Mailing Address - Phone:954-575-4040
Mailing Address - Fax:954-575-4049
Practice Address - Street 1:1801 N UNIVERSITY DR
Practice Address - Street 2:SUITE209
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8920
Practice Address - Country:US
Practice Address - Phone:954-575-4040
Practice Address - Fax:954-575-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63185OtherUPIN
FL0475769Medicaid
FLD63185OtherUPIN