Healthcare Provider Details

I. General information

NPI: 1265437891
Provider Name (Legal Business Name): JORDAN BLAKE SCHWARTZBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 GLADES RD SUITE 207
BOCA RATON FL
33434-3988
US

IV. Provider business mailing address

7740 BOYNTON BEACH BLVD
BOYNTON BEACH FL
33437-3804
US

V. Phone/Fax

Practice location:
  • Phone: 561-487-7575
  • Fax: 561-487-7576
Mailing address:
  • Phone: 561-752-8000
  • Fax: 561-752-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME83158
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME83158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: