Provider Demographics
NPI:1588068100
Name:TEAMHEALTH
Entity type:Organization
Organization Name:TEAMHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY MEDICINE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-242-1353
Mailing Address - Street 1:17431 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3103
Mailing Address - Country:US
Mailing Address - Phone:863-242-1353
Mailing Address - Fax:
Practice Address - Street 1:17431 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3103
Practice Address - Country:US
Practice Address - Phone:863-242-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108237207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty