Healthcare Provider Details

I. General information

NPI: 1255529186
Provider Name (Legal Business Name): WEST BOCA PHYSICIANS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21644 STATE ROAD 7
BOCA RATON FL
33428-1842
US

IV. Provider business mailing address

14050 NW 14TH ST SUITE 190
SUNRISE FL
33323-2865
US

V. Phone/Fax

Practice location:
  • Phone: 561-883-7029
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN G. HOLTZCLAW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-424-3672