Organization
SEA RANCH GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIGIDA FENELON (DIRECTOR OF BUSINESS OPERATIONS)
(954) 451-3010
Entity
Organization
Contact information
Practice address
4701 N FEDERAL HWY STE A39, FORT LAUDERDALE, FL 33308-4608
(954) 651-9771
Mailing address
4701 N FEDERAL HWY STE A39, FORT LAUDERDALE, FL 33308-4608
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051855700
—
FL
Enumeration date
11/07/2017
Last updated
11/07/2017
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