Basic Information
Provider Information | |||||||||
NPI: | 1083711790 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PEDIATRIX MEDICAL GROUP OF FLORIDA INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | OLIVER | ||||||||
AuthorizedOfficialFirstName: | ALAN | ||||||||
AuthorizedOfficialMiddleName: | BRAD | ||||||||
AuthorizedOfficialTitleorPosition: | AUTHORIZED SIGNATOR | ||||||||
AuthorizedOfficialTelephone: | 9543840175 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/28/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207VM0101X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 2080N0001X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 2080P0008X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities | 2080P0203X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 2080P0205X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | 208200000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |   | 2088P0231X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 208M00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |   | 2080P0202X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
ID | Type | State | Issuer | Description | 002741914 | 05 | FL |   | MEDICAID | 002741925 | 05 | FL |   | MEDICAID | 002741941 | 05 | FL |   | MEDICAID | 002741948 | 05 | FL |   | MEDICAID | 060035198 | 05 | FL |   | MEDICAID | 002741908 | 05 | FL |   | MEDICAID | 002741912 | 05 | FL |   | MEDICAID | 002741935 | 05 | FL |   | MEDICAID | 002741940 | 05 | FL |   | MEDICAID | 060035156 | 05 | FL |   | MEDICAID | 002741900 | 05 | FL |   | MEDICAID | 002741905 | 05 | FL |   | MEDICAID | 002741906 | 05 | FL |   | MEDICAID | 002741910 | 05 | FL |   | MEDICAID | 002741911 | 05 | FL |   | MEDICAID | 002741922 | 05 | FL |   | MEDICAID | 002741923 | 05 | FL |   | MEDICAID | 002741924 | 05 | FL |   | MEDICAID | 002741927 | 05 | FL |   | MEDICAID | 002741932 | 05 | FL |   | MEDICAID | 002741934 | 05 | FL |   | MEDICAID | 002741938 | 05 | FL |   | MEDICAID | 002741944 | 05 | FL |   | MEDICAID | 002741951 | 05 | FL |   | MEDICAID | 002741907 | 05 | FL |   | MEDICAID | 002741929 | 05 | FL |   | MEDICAID | 002741930 | 05 | FL |   | MEDICAID | 002741956 | 05 | FL |   | MEDICAID | 060035157 | 05 | FL |   | MEDICAID | 060035169 | 05 | FL |   | MEDICAID | 269595221 | 05 | FL |   | MEDICAID | 002741920 | 05 | FL |   | MEDICAID | 002741936 | 05 | FL |   | MEDICAID | 002741946 | 05 | FL |   | MEDICAID | 060035176 | 05 | FL |   | MEDICAID | 002741903 | 05 | FL |   | MEDICAID | 002741926 | 05 | FL |   | MEDICAID | 002741939 | 05 | FL |   | MEDICAID | 002741942 | 05 | FL |   | MEDICAID | 002741913 | 05 | FL |   | MEDICAID | 002741919 | 05 | FL |   | MEDICAID | 002741931 | 05 | FL |   | MEDICAID | 002741937 | 05 | FL |   | MEDICAID | 002741945 | 05 | FL |   | MEDICAID | 002741947 | 05 | FL |   | MEDICAID | 002741958 | 05 | FL |   | MEDICAID |