Provider Demographics
NPI:1366723777
Name:PHYSICIAN ASSOCIATES OF BROWARD INC
Entity type:Organization
Organization Name:PHYSICIAN ASSOCIATES OF BROWARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-322-3603
Mailing Address - Street 1:9900 STIRLING RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8065
Mailing Address - Country:US
Mailing Address - Phone:954-322-3603
Mailing Address - Fax:954-322-5303
Practice Address - Street 1:9900 STIRLING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8065
Practice Address - Country:US
Practice Address - Phone:954-322-3603
Practice Address - Fax:954-322-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
42635OtherBCBS
42635OtherBCBS