Healthcare Provider Details

I. General information

NPI: 1104933084
Provider Name (Legal Business Name): BOCA RATON ORTHOPEDIC GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 GLADES RD SUITE 460
BOCA RATON FL
33431-6465
US

IV. Provider business mailing address

660 GLADES RD SUITE 460
BOCA RATON FL
33431-6465
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-5515
  • Fax: 561-347-7470
Mailing address:
  • Phone: 561-391-5515
  • Fax: 561-347-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JOHN EDWARD HORNBERGER
Title or Position: CEO
Credential:
Phone: 561-391-5515