Basic Information
| Provider Information | |||||||||
| NPI: | 1710487145 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPAEDIC CENTER OF S FLORIDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S PINE ISLAND RD STE 300 | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544736344 | ||||||||
| FaxNumber: | 9544738119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1414 SE 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333161910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544736344 | ||||||||
| FaxNumber: | 9544738119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2018 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | MORAZAN | ||||||||
| AuthorizedOfficialFirstName: | JOSSLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 9544736344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.