Healthcare Provider Details

I. General information

NPI: 1821610122
Provider Name (Legal Business Name): CGM DIABETIC SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N FEDERAL HWY STE 210-49
BOCA RATON FL
33431-5187
US

IV. Provider business mailing address

1271 SW 13TH DR
BOCA RATON FL
33486-5364
US

V. Phone/Fax

Practice location:
  • Phone: 561-570-5915
  • Fax:
Mailing address:
  • Phone: 561-299-6893
  • 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: WILLIAM ROBERT BAYLIS
Title or Position: AUTHORIZED MEMBER
Credential:
Phone: 561-570-5915