PHOENIX OBSTETRICS-GYNECOLOGY LLC (NPI# 1285637066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285637066 |
| Entity Type | Organization |
| Organization Name | PHOENIX OBSTETRICS-GYNECOLOGY LLC |
| Practice Address |
1600 S Andrews Ave Suite 323, West Wing Ft Lauderdale FL 33316-2510 |
| Mailing Address |
3114 Croasdaile Dr Ste 200 Phoenix Obstetrics/gynecology, LLC Durham NC 27705-2508 |
| Practice Telephone | 9543555110 |
| Practice Fax Number | 9194250478 |
| Mailing Telephone | 9194251565 |
| Mailing Fax Number | 9194250478 |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2019-08-10 |
| Authorized Official Name | DR. BERTRAM WALLS (PRESIDENT) |
| Authorized Official Telephone | 9548382371 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | ME43546 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 269096900 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003321118 | Phoenix Obstetrics-gynecology LLC | Obstetrics & Gynecology | 601 W Atlantic Blvd Fl 2, Pompano Beach, FL 33060-5916 | 2017-12-12 |
| Street Address |
1600 S ANDREWS AVE SUITE 323, WEST WING |
| City | FT LAUDERDALE |
| State | FL |
| Zip Code | 33316-2510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285253542 | Carmen S Ceron Velasquez | Student in an Organized Health Care Education/Training Program | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2020-04-15 |
| 1538788567 | Chris Angelo Haritos Jr. | Student in an Organized Health Care Education/Training Program | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2020-04-09 |
| 1699260018 | Estefania Romina Niewialkouski | Pediatrics | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2018-06-27 |
| 1992200919 | Charee Howard | Family Medicine | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2018-03-30 |
| 1780190264 | Justin Limtong | Orthopaedic Surgery | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2017-12-20 |
| 1114459625 | Amy Surti | Internal Medicine | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2017-04-03 |
| 1417497280 | Elizabeth Fernandez | Pediatrics | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2017-02-27 |
| 1407394562 | Broward General Medical Center | General Acute Care Hospital | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2017-02-08 |
| 1346788155 | Charles Cevallos | Internal Medicine | 1600 S Andrews Ave, Ft Lauderdale, FL 33316-2510 | 2017-02-01 |
| 1972040681 | Bijan Joseph Ameri | Orthopaedic Surgery | 1600 S Andrews Ave, Ft Lauderdale, FL 33316 | 2017-01-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366064040 | Jonathan David Ortiz | Behavior Technician | 1717 Se 4 Ave, Fort Lauderdale, FL 33316 | 2020-05-15 |
| 1306311626 | Gateway Recovery Center, LLC | Counselor | 1421 Sw 4th Avenue, Suite B, Fort Lauderdale, FL 33316 | 2018-10-13 |
| 1588141626 | Natan Bastoky | Family Medicine | 1600 S Andrews Ave # Gme, Fort Lauderdale, FL 33316 | 2018-07-22 |
| 1104320126 | Kathleen Kanani Graham | Pharmacist | 1401 S. Federal Highway, Ft. Lauderdale, FL 33316 | 2018-03-23 |
| 1093224271 | Lacosta Therapy, LLC | Behavioral Analyst | 412 Se 15 St., #4, Ft. Lauderdale, FL 33316 | 2017-09-20 |
| 1124560370 | Yulia Rybalka | Pharmacist | 217 Se 10th Street, Ft Lauderdale, FL 33316 | 2016-11-04 |
| 1730635376 | Brian Alexander Reyes | Specialist/Technologist | 303 Se 3rd Ave, Ft Lauderdale, FL 33316 | 2016-09-01 |
| 1649726282 | Jennifer Tabares | Specialist/Technologist | 303 Southeast 3rd Av, Fort Lauderdale, FL 33316 | 2016-09-01 |
| 1609236850 | Diane Nicole Shilling | Nurse Practitioner | 1001 South Andrews Avenue, Suite 100, Ft. Lauderdale, FL 33316 | 2016-03-01 |
| 1396113239 | Victoria Rosado | Adult Companion | 150 Se 12th Street, 401(b), Fort Lauderdale, FL 33316 | 2015-09-09 |
| Find all providers in zip 33316 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659664175 | Melissa Ann Kushlak | Obstetrics & Gynecology | 2466 E Commercial Blvd Ste 101, Ft Lauderdale, FL 33308 | 2011-05-17 |
| 1639283781 | Uzi Bodman | Obstetrics & Gynecology | 3305 Ne 40th St, Ft Lauderdale, FL 33308-6411 | 2006-08-18 |
| 1154323640 | Miguel Angel Gonzalez | Obstetrics & Gynecology | 401 Se 16th St, Ft Lauderdale, FL 33316-2529 | 2005-08-15 |
| 1831191568 | Rachel Corey Bernstein | Obstetrics & Gynecology | 4701 N Federal Hwy, Building B, Ft Lauderdale, FL 33308-4608 | 2005-08-12 |
| 1336147693 | Earle M Pescatore Jr. | Obstetrics & Gynecology | 2021 E Commercial Blvd, Suite 305, Ft Lauderdale, FL 33308-3763 | 2005-07-11 |
| 1679913206 | George B Maroulis | Obstetrics & Gynecology | 1600 S Andrews Ave, Suite 1090 West Wing, Ft Lauderdale, FL 33316-2510 | 2013-06-27 |
| 1598058935 | Sweta Tina Mehta | Obstetrics & Gynecology | 2466 E Commercial Blvd Ste 101, Ft Lauderdale, FL 33308 | 2011-05-18 |
| 1922320662 | Quik Clinic Medical Center | Obstetrics & Gynecology | 4055 N Andrews Ave, Ft Lauderdale, FL 33309-5269 | 2010-02-23 |
| 1467569244 | Patricia Calvo | Obstetrics & Gynecology | 4701 N Federal Hwy, Bldg. B, Ft Lauderdale, FL 33308-4608 | 2006-08-25 |
| 1033226881 | Ghea Adeboyejo | Obstetrics & Gynecology | 4701 N Federal Hwy, Bldg B, Ft Lauderdale, FL 33308-4608 | 2006-08-25 |
| Find all providers in FT LAUDERDALE | ||||
| City | FT LAUDERDALE |
| Zip Code | 33316 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.