Provider Demographics
NPI:1033788831
Name:SOUTH FLORIDA MEDICAL PRACTICE LLC
Entity type:Organization
Organization Name:SOUTH FLORIDA MEDICAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURDOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-392-3341
Mailing Address - Street 1:398 CAMINO GARDENS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5827
Mailing Address - Country:US
Mailing Address - Phone:561-392-3341
Mailing Address - Fax:561-392-3793
Practice Address - Street 1:3475 SHERIDAN ST STE 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3633
Practice Address - Country:US
Practice Address - Phone:561-392-3341
Practice Address - Fax:561-392-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1234OtherOTHER