MEDICARE: PHYSICIANS CARE PLUS OF LAKE WORTH

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1902104086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS CARE PLUS OF LAKE WORTH

Provider Business Mailing Address
First Line	:	6432 LAKE WORTH ROAD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463
Country	:	US
Telephone Number	:	561-967-2334
Fax Number	:

Provider Business Practice Location Address
First Line	:	6432 LAKE WORTH ROAD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463
Country	:	US
Telephone Number	:	561-967-2334
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PAYER RELATIONS
Name	:	PETER J ANZALONE
Credential	:
Telephone Number	:	954-318-6590

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/14/2011

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