St. George Spinal Clinic PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME65248 Issued in FL

Legal business name

ST. GEORGE SPINAL CLINIC PA

Practice address

4469 N State Road 7
Lauderdale Lakes, FL 33319-5876

Phone

(954) 486-1966

Fax

(954) 486-9115

NPI assigned

Jul 25, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Wagdy B. Tadros, MDNPI 1114952413

Title

Physician

Phone

(954) 486-1966

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wagdy Tadros, M.D.

  • Internal Medicine Physician
  • Lauderdale Lakes, FL
  • NPI 1114952413
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314316800000",
    "number": "1609898683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10693",
            "city": "RIVIERA BEACH",
            "state": "FL",
            "postal_code": "334190693",
            "telephone_number": "954-486-1966",
            "fax_number": "954-486-9115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4469 N STATE ROAD 7",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195876",
            "telephone_number": "954-486-1966",
            "fax_number": "954-486-9115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. GEORGE SPINAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2011-08-26",
        "status": "A",
        "authorized_official_last_name": "TADROS",
        "authorized_official_first_name": "WAGDY",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "954-486-1966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME65248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2621902",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID",
            "identifier": "25940",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "234955",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Lauderdale Lakes, FL
• Providers in Lauderdale Lakes, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.