| Entity Name: | LAWRENCE E. BRODER, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 26 Apr 1990 (35 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L68309 |
| FEI/EIN Number | 65-0185968 |
| Address: | 8740 SW 182 TERR, MIAMI, FL 33157 |
| Mail Address: | 8740 SW 182 TERR, MIAMI, FL 33157 |
| ZIP code: | 33157 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679583769 | 2006-08-09 | 2008-10-30 | 8740 SW 182ND TER, VILLAGE OF PALMETTO BAY, FL, 331575952, US | 45 NW 8TH ST, SUITE 104, HOMESTEAD, FL, 330304452, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-238-1212 |
| Fax | 3052388191 |
| Phone | +1 305-246-5500 |
| Fax | 3052460081 |
Authorized person
| Name | DR. LAWRENCE BRODER |
| Role | PRESIDENT |
| Phone | 3052381212 |
Taxonomy
| Taxonomy Code | 207RX0202X - Medical Oncology Physician |
| License Number | ME0027628 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AMERIGROUP HMO |
| Number | 210135 |
| State | FL |
| Issuer | AVMED HMO |
| Number | 221246 |
| State | FL |
| Issuer | MEDICAID |
| Number | 370009700 |
| State | FL |
| Issuer | JMH HMO |
| Number | 55027 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRODER, LAWRENCE E | Agent | 8740 SW 182 TERR, MIAMI, FL 33157 |
| Name | Role | Address |
|---|---|---|
| BRODER, LAWRENCE E | President | 8740 SW 182 TERR, MIAMI, FL 33157 |
| Name | Role | Address |
|---|---|---|
| BRODER, LAWRENCE E | Director | 8740 SW 182 TERR, MIAMI, FL 33157 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2009-02-16 | BRODER, LAWRENCE E | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-02-16 | 8740 SW 182 TERR, MIAMI, FL 33157 | No data |
| CHANGE OF MAILING ADDRESS | 2009-02-16 | 8740 SW 182 TERR, MIAMI, FL 33157 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2002-07-17 | 8740 SW 182 TERR, MIAMI, FL 33157 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-02-12 |
| ANNUAL REPORT | 2011-01-09 |
| ANNUAL REPORT | 2010-01-05 |
| ANNUAL REPORT | 2009-02-16 |
| ANNUAL REPORT | 2008-01-06 |
| ANNUAL REPORT | 2007-01-03 |
| ANNUAL REPORT | 2006-01-18 |
| ANNUAL REPORT | 2005-01-03 |
| ANNUAL REPORT | 2004-04-23 |
| ANNUAL REPORT | 2003-01-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
