Provider Demographics
NPI:1043462799
Name:PERFORMANCE ORTHOPAEDIC
Entity type:Organization
Organization Name:PERFORMANCE ORTHOPAEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEVORAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-765-3200
Mailing Address - Street 1:721 SE 17TH ST
Mailing Address - Street 2:#104
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2983
Mailing Address - Country:US
Mailing Address - Phone:954-765-3200
Mailing Address - Fax:786-975-2643
Practice Address - Street 1:721 SE 17TH ST
Practice Address - Street 2:#104
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2983
Practice Address - Country:US
Practice Address - Phone:954-765-3200
Practice Address - Fax:786-975-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty