MEDICARE: THE PALM BEACH CENTER FOR FACIAL PLASTIC & LASER SURGERY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	ME134770	FL
2	207YS0123X	Facial Plastic Surgery Physician	ME117560	FL

General Provider Information

NPI Number	:	1225448921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PALM BEACH CENTER FOR FACIAL PLASTIC & LASER SURGERY, P.A.

Provider Business Mailing Address
First Line	:	4495 MILITARY TRL
Second Line	:	SUITE 202
City	:	JUPITER
State	:	FL
Zip	:	33458-4839
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4495 MILITARY TRL STE 202
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458
Country	:	US
Telephone Number	:	561-429-5403
Fax Number	:	561-626-6277

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEAN PAUL AZZI
Credential	:	M.D.
Telephone Number	:	561-429-5403

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	08/27/2018

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