MEDICARE: JORDAN BLAKE SCHWARTZBERG MD

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	207ND0101X	MOHS-Micrographic Surgery Physician	ME83158	FL
2	207N00000X	Dermatology Physician	ME83158	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43286Y	OTHER	FL	MEDICARE ID

General Provider Information

NPI Number	:	1265437891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN BLAKE SCHWARTZBERG MD

Provider Business Mailing Address
First Line	:	7740 BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3804
Country	:	US
Telephone Number	:	561-752-8000
Fax Number	:	561-752-8001

Provider Business Practice Location Address
First Line	:	9325 GLADES RD
Second Line	:	SUITE 207
City	:	BOCA RATON
State	:	FL
Zip	:	33434-3988
Country	:	US
Telephone Number	:	561-487-7575
Fax Number	:	561-487-7576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	10/05/2015

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