Basic Information
| Provider Information | |||||||||
| NPI: | 1922153287 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEERFIELD MEDICAL GROUP LLC | ||||||||
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| OtherOrganizationName: | SUSSMAN MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1979 W HILLSBORO BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334421444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544284800 | ||||||||
| FaxNumber: | 9544284909 | ||||||||
| Practice Location | |||||||||
| Address1: | 1979 W HILLSBORO BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334421444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544284800 | ||||||||
| FaxNumber: | 9544284909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 06/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9544284800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | HCC7879 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | HCC7879 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.