Provider Demographics
NPI:1447092325
Name:FAU BROWARD HEALTH ACADEMIC PRACTICE PLAN INC
Entity type:Organization
Organization Name:FAU BROWARD HEALTH ACADEMIC PRACTICE PLAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-786-6449
Mailing Address - Street 1:2100 E SAMPLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7574
Mailing Address - Country:US
Mailing Address - Phone:954-958-7195
Mailing Address - Fax:954-958-7115
Practice Address - Street 1:1 W SAMPLE RD STE 301
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-958-7195
Practice Address - Fax:954-958-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty