Organization
LA CLINIQUE 300 INC
Active
Parent organization
JOSEPH FANFAN JR MD PA
Other names
JOSEPH FANFAN JR MD PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
JOSEPH FANFAN JR MD PA
Authorized official
DR. JOSEPH FANFAN MD (PRESIDENT)
(954) 525-4900
Entity
Organization
Contact information
Practice address
2630 N ANDREWS AVE, WILTON MANORS, FL 33311-2550
(954) 525-4900
(954) 396-3110
Mailing address
2630 N ANDREWS AVE, WILTON MANORS, FL 33311-2550
(954) 525-4900
(954) 396-3110
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME43065
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068166100
—
FL
Enumeration date
07/22/2015
Last updated
05/09/2016
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