Provider Demographics
NPI:1659112209
Name:SOUTH FLORIDA ORTHOPAEDICS & SPORTS MEDICINE, PA
Entity type:Organization
Organization Name:SOUTH FLORIDA ORTHOPAEDICS & SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-288-2400
Mailing Address - Street 1:1050 SE MONTEREY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:561-627-8500
Mailing Address - Fax:
Practice Address - Street 1:4560 LANTANA RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6998
Practice Address - Country:US
Practice Address - Phone:561-627-8500
Practice Address - Fax:844-959-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies