MEDICARE: MY DOCTOR PA

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	OS-0005579	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992785513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY DOCTOR PA

Provider Business Mailing Address
First Line	:	1200 S MAIN ST
Second Line	:	SUITE 200
City	:	BELLE GLADE
State	:	FL
Zip	:	33430-7808
Country	:	US
Telephone Number	:	561-992-8000
Fax Number	:	561-992-8020

Provider Business Practice Location Address
First Line	:	1200 S MAIN ST
Second Line	:	SUITE 200
City	:	BELLE GLADE
State	:	FL
Zip	:	33430-7808
Country	:	US
Telephone Number	:	561-992-8000
Fax Number	:	561-992-8020

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MARTIN TRACY HARLAND
Credential	:	D.O.
Telephone Number	:	561-992-8000

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	04/28/2011

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Directions to “MY DOCTOR PA ” Practice Location

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