Provider Demographics
NPI:1194129759
Name:PREMIERMD MSO,LLC
Entity type:Organization
Organization Name:PREMIERMD MSO,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-566-7717
Mailing Address - Street 1:3465 GALT OCEAN DR
Mailing Address - Street 2:SUITE#203
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7077
Mailing Address - Country:US
Mailing Address - Phone:954-561-5135
Mailing Address - Fax:
Practice Address - Street 1:3465 GALT OCEAN DR
Practice Address - Street 2:SUITE#203
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7077
Practice Address - Country:US
Practice Address - Phone:954-561-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty