Healthcare Provider Details

I. General information

NPI: 1972066876
Provider Name (Legal Business Name): PULMONARY AND SLEEP MEDICINE OF PALM BEACH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 S SEACREST BLVD STE 214
BOYNTON BEACH FL
33435-7532
US

IV. Provider business mailing address

2623 S SEACREST BLVD STE 214
BOYNTON BEACH FL
33435-7532
US

V. Phone/Fax

Practice location:
  • Phone: 561-602-3739
  • Fax:
Mailing address:
  • Phone: 561-602-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FERNANDO KELLER
Title or Position: PRESIDENT
Credential: MD
Phone: 561-602-3739