Healthcare Provider Details

I. General information

NPI: 1922690486
Provider Name (Legal Business Name): EUGENE LEON WAY II CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2021
Last Update Date: 02/06/2021
Certification Date: 02/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CAMINO GARDENS BLVD STE 104
BOCA RATON FL
33432-5823
US

IV. Provider business mailing address

747 KINGSTON CT
APOLLO BEACH FL
33572-2428
US

V. Phone/Fax

Practice location:
  • Phone: 561-494-4499
  • Fax:
Mailing address:
  • Phone: 813-787-8267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License NumberTT7754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: