Provider Demographics
NPI:1215165121
Name:SOUTH BROWARD VASCULAR ASSOCIATES LLC
Entity type:Organization
Organization Name:SOUTH BROWARD VASCULAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-989-5533
Mailing Address - Street 1:3850 HOLLYWOOD BLVD
Mailing Address - Street 2:302
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6748
Mailing Address - Country:US
Mailing Address - Phone:954-989-5533
Mailing Address - Fax:954-989-5677
Practice Address - Street 1:3850 HOLLYWOOD BLVD
Practice Address - Street 2:302
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6748
Practice Address - Country:US
Practice Address - Phone:954-989-5533
Practice Address - Fax:954-989-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME718362086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty