STACY HOLDER DPM PA
Medical Practice at 123 Ave, Hollywood, FL

License number
Florida PO3583
Category
Medical Practice
Type
Foot & Ankle Surgery
Owner
Name: DR. STACY HOLDER SHEWPRASHAD D.P.M.
Title: OWNER
Phone: (954) 391-7674
Address
Address
1791 NW 123Rd Ave, Hollywood, FL 33026
National Provider ID: 1447671326
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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STACY HOLDER, D.P.M., PA

Hollywood, FL

Industry:
Podiatrist's Office
Registration:
Nov 26, 2013
Addresses:
1791 NW 123 Ave, Hollywood, FL 33026 (Physical)
12842 SW 53 Ct, Hollywood, FL 33027 (Mailing)
12879 SW 31 Ct, Hollywood, FL 33027
State ID:
P13000095510
Business type:
Florida Profit Corporation
S:
Stacy H Shewprashad (Secretary, President), 1791 NW 123 Ave, Hollywood, FL 33026 (Physical),Rawle L Shewprashad (Vice President), 1791 NW 123 Ave, Hollywood, FL 33026 (Physical),Stacy Holder President, inactive,...
Agent:
Stacy Shewprashad,1791 NW 123 Ave, Hollywood, FL 33026 (Physical)
EIN:
46-4206399

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