Basic Information
Provider Information
NPI: 1083711790
EntityType: 2
ReplacementNPI:  
OrganizationName: PEDIATRIX MEDICAL GROUP OF FLORIDA INC
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Mailing Information
Address1: 1301 CONCORD TER
Address2:  
City: SUNRISE
State: FL
PostalCode: 333232843
CountryCode: US
TelephoneNumber: 9543840175
FaxNumber: 9548511948
Practice Location
Address1: 1301 CONCORD TER
Address2:  
City: SUNRISE
State: FL
PostalCode: 333232843
CountryCode: US
TelephoneNumber: 9543840175
FaxNumber: 9548511948
Other Information
ProviderEnumerationDate: 09/17/2006
LastUpdateDate: 04/28/2021
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: OLIVER
AuthorizedOfficialFirstName: ALAN
AuthorizedOfficialMiddleName: BRAD
AuthorizedOfficialTitleorPosition: AUTHORIZED SIGNATOR
AuthorizedOfficialTelephone: 9543840175
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate: 04/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207VM0101X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
2080N0001X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
2080P0008X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
2080P0203X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
2080P0205X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
208200000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPlastic Surgery 
2088P0231X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
208M00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansHospitalist 
2080P0202X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

ID Information
IDTypeStateIssuerDescription
00274191405FL MEDICAID
00274192505FL MEDICAID
00274194105FL MEDICAID
00274194805FL MEDICAID
06003519805FL MEDICAID
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00274193705FL MEDICAID
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