Ortho Florida, LLC

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

Legal business name

ORTHO FLORIDA, LLC

Doing business as

J Provo, MD

Practice address

4705 N Federal Hwy
Boca Raton, FL 33431-4953

Phone

(561) 405-9610

NPI assigned

Sep 15, 2014

Last updated

Oct 2, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

ORTHO FLORIDA, LLCAs reported in NPPES

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

Authorized official

Name

Dane Trask

Title

Coo

Phone

(813) 787-1128

Specialties & licenses 1

Addresses

Other names 1

• J Provo, MD Doing business as

Part of

Ortho Florida LLC

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

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443744000000",
    "number": "1881095479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 PARK OF COMMERCE DR",
            "address_2": "STE 112",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334873626",
            "telephone_number": "561-300-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 N FEDERAL HWY",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314953",
            "telephone_number": "561-405-9610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO FLORIDA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ORTHO FLORIDA, LLC",
        "enumeration_date": "2014-09-15",
        "last_updated": "2015-10-02",
        "status": "A",
        "authorized_official_last_name": "TRASK",
        "authorized_official_first_name": "DANE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "813-787-1128"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "J Provo, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sports Medicine (Orthopaedic Surgery) Physician in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; 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.