Provider Demographics
NPI:1487970810
Name:FAMILY PHYSICIANS OF SOUTH FLORIDA
Entity type:Organization
Organization Name:FAMILY PHYSICIANS OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANSARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-942-2922
Mailing Address - Street 1:1955 N FEDERAL HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1028
Mailing Address - Country:US
Mailing Address - Phone:954-942-2922
Mailing Address - Fax:954-942-5352
Practice Address - Street 1:2001 N FEDERAL HWY
Practice Address - Street 2:SUITE 301-303
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1030
Practice Address - Country:US
Practice Address - Phone:954-942-2922
Practice Address - Fax:954-942-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME10062261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care