Healthcare Provider Details

I. General information

NPI: 1821031048
Provider Name (Legal Business Name): MEDICAL SPECIALISTS OF THE PALM BEACHES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE STE 218
ATLANTIS FL
33462-6337
US

IV. Provider business mailing address

5700 LAKE WORTH RD #204
GREENACRES FL
33463-4727
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-0500
  • Fax: 561-968-7673
Mailing address:
  • Phone: 561-968-7698
  • Fax: 561-964-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CASEY WATERS
Title or Position: CEO
Credential:
Phone: 561-649-7000