Provider Demographics
NPI:1316052632
Name:TOTAL WOMENS HEALTHCARE OF PLANTATION
Entity type:Organization
Organization Name:TOTAL WOMENS HEALTHCARE OF PLANTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RALPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-791-2810
Mailing Address - Street 1:333 NW 70TH AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-791-2810
Mailing Address - Fax:954-791-9810
Practice Address - Street 1:333 NW 70TH AVE
Practice Address - Street 2:STE 120
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-791-2810
Practice Address - Fax:954-791-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36825207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93814OtherBCBS
FL005697OtherAVMED
FL2258482OtherAETNA
FL93814OtherBCBS
D78827Medicare UPIN