Healthcare Provider Details

I. General information

NPI: 1174432348
Provider Name (Legal Business Name): JASON GOLUB, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 GLADES RD STE 110
BOCA RATON FL
33431-6466
US

IV. Provider business mailing address

17761 VECINO WAY
BOCA RATON FL
33496-1058
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-7575
  • Fax:
Mailing address:
  • Phone: 631-805-3810
  • Fax:

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: JASON GOLUB
Title or Position: OWNER
Credential:
Phone: 631-805-3810