Provider Demographics
NPI:1841555786
Name:BROWARD DERMATOLOGY
Entity type:Organization
Organization Name:BROWARD DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:OBED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-990-6591
Mailing Address - Street 1:500 SE 15TH ST
Mailing Address - Street 2:SUITE #108
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1952
Mailing Address - Country:US
Mailing Address - Phone:954-990-6591
Mailing Address - Fax:
Practice Address - Street 1:500 SE 15TH ST
Practice Address - Street 2:SUITE #108
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1952
Practice Address - Country:US
Practice Address - Phone:954-990-6591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9463261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS9463OtherMEDICAL LICENSE