Healthcare Provider Details

I. General information

NPI: 1124635800
Provider Name (Legal Business Name): MD HEALTH SOURCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 CAMINO GARDENS BLVD STE 210B
BOCA RATON FL
33432-5818
US

IV. Provider business mailing address

370 CAMINO GARDENS BLVD STE 210B
BOCA RATON FL
33432-5818
US

V. Phone/Fax

Practice location:
  • Phone: 800-793-3122
  • Fax:
Mailing address:
  • Phone: 800-793-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JON DUBOIS
Title or Position: OWNER
Credential:
Phone: 800-793-3122