Organization · NPI-2

360 Medical PA

Internal Medicine, Nephrology · Fort Lauderdale, FL

NPI number1508096330
StatusActive
Last updated in NPPESAug 4, 2009

Details

NPI
1508096330
Entity type
Organization (NPI-2)
Legal business name
360 Medical PA
Organization subpart
No
Enumeration date
Jul 14, 2009
Last updated
Aug 4, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RN0300X Internal Medicine, NephrologyOS7637FLYes

Practice location

2004 Ne 49th St
Fort Lauderdale, FL 33308-4524

Phone 954-790-2251 · Fax 954-206-2200

Mailing address

2004 Ne 49th St
Fort Lauderdale, FL 33308-4524

Phone 954-790-2251 · Fax 954-206-2200

Authorized official

Lan T Phan
President
9547902251

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