NPIMap

Organization Active NPI

Phoenix Obsterics/Gynecology, LLC

  • Obstetrics & Gynecology Physician
  • Fort Lauderdale, FL
National Provider Identifier
1568411700
Registry record updated Aug 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME43546 Issued in FL
Legal business name
PHOENIX OBSTERICS/GYNECOLOGY, LLC
Practice address
500 SE 17TH St
Suite 100
Ft Lauderdale, FL 33316-2547
Phone
(919) 425-1565
Fax
(919) 425-0478
NPI assigned
May 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bertram Walls, MD
Title
President
Phone
(954) 838-2371

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X ME43546 FL Primary

Addresses

Primary practice location

500 SE 17TH St
Suite 100
Ft Lauderdale, FL 33316-2547

Mailing address

3114 Croasdaile Dr Ste 200
Phoenix Obstetrics/Gynecology, LLC
Durham, NC 27705-2508
Phone (919) 425-1565

Other identifiers 1

IdentifierTypeStateIssuer
269096903MedicaidFL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565395200000",
    "number": "1568411700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3114 CROASDAILE DR STE 200",
            "address_2": "PHOENIX OBSTETRICS/GYNECOLOGY, LLC",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277052508",
            "telephone_number": "919-425-1565",
            "fax_number": "919-425-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SE 17TH ST",
            "address_2": "SUITE 100",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162547",
            "telephone_number": "919-425-1565",
            "fax_number": "919-425-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX OBSTERICS/GYNECOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-06",
        "last_updated": "2019-08-10",
        "status": "A",
        "authorized_official_last_name": "WALLS",
        "authorized_official_first_name": "BERTRAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-838-2371",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME43546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269096903",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.