Healthcare Provider Details

I. General information

NPI: 1689061202
Provider Name (Legal Business Name): PALM BEACH MEDICAL WEIGHT LOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SE 27TH AVE
BOYNTON BEACH FL
33435-7632
US

IV. Provider business mailing address

101 SE 27TH AVE
BOYNTON BEACH FL
33435-7632
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-8844
  • Fax: 561-738-5592
Mailing address:
  • Phone: 561-737-8844
  • Fax: 561-738-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DAVID LASHWAY
Title or Position: OWNER
Credential: M.D.
Phone: 561-737-8844