PCP of Lauderdale LKS

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PCP OF LAUDERDALE LKS

Practice address

4900 W Oakland Park Blvd
North BLD Suite 301
Lauderdale Lakes, FL 33313-7500

Phone

(954) 484-4154

NPI assigned

Mar 5, 2007

Organization subpart

No

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

Authorized official

Name

Peter Anzalone

Title

Director

Phone

(954) 318-6590

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881723922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 W OAKLAND PARK BLVD",
            "address_2": "NORTH BLD SUITE 301",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333137500",
            "telephone_number": "954-484-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 W OAKLAND PARK BLVD",
            "address_2": "NORTH BLD SUITE 301",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333137500",
            "telephone_number": "954-484-4154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCP OF LAUDERDALE LKS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANZALONE",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "954-318-6590"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.