Provider Demographics
NPI:1285075499
Name:S J DEPRIMA MD RADIOLOGY PA
Entity type:Organization
Organization Name:S J DEPRIMA MD RADIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEPRIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-871-6826
Mailing Address - Street 1:PO BOX 431306
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-1306
Mailing Address - Country:US
Mailing Address - Phone:305-661-7026
Mailing Address - Fax:305-663-7316
Practice Address - Street 1:6129 SW 70TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3451
Practice Address - Country:US
Practice Address - Phone:786-871-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374522800Medicaid