Provider Demographics
NPI:1801146162
Name:SOUTH FLORIDA DIAGNOSTIC RESOURCES
Entity type:Organization
Organization Name:SOUTH FLORIDA DIAGNOSTIC RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-629-2188
Mailing Address - Street 1:3345 BURNS RD
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4324
Mailing Address - Country:US
Mailing Address - Phone:954-629-2188
Mailing Address - Fax:800-741-3205
Practice Address - Street 1:3345 BURNS RD
Practice Address - Street 2:SUITE 105B
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4324
Practice Address - Country:US
Practice Address - Phone:954-629-2188
Practice Address - Fax:800-741-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME774502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty