Provider Demographics
NPI:1902895790
Name:AVERBUCH, PHILIP FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:FRED
Last Name:AVERBUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 NW 33RD ST STE 116
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4000
Mailing Address - Country:US
Mailing Address - Phone:954-722-0040
Mailing Address - Fax:954-344-7964
Practice Address - Street 1:9750 NW 33RD ST STE 116
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4000
Practice Address - Country:US
Practice Address - Phone:954-722-0040
Practice Address - Fax:954-344-7964
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM023424207X00000X
FLM23434207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054001300Medicaid
FL054001300Medicaid
FL78010Medicare PIN