Provider Demographics
NPI:1699234534
Name:BREAST SPECIALISTS OF SOUTH FLORIDA, LLC
Entity type:Organization
Organization Name:BREAST SPECIALISTS OF SOUTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-510-2337
Mailing Address - Street 1:130 JFK DR STE 132
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1133
Mailing Address - Country:US
Mailing Address - Phone:561-510-2337
Mailing Address - Fax:561-510-2340
Practice Address - Street 1:130 JFK DR STE 132
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1133
Practice Address - Country:US
Practice Address - Phone:561-510-2337
Practice Address - Fax:561-510-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty