Healthcare Provider Details

I. General information

NPI: 1548808082
Provider Name (Legal Business Name): PRYME MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW 3RD ST STE 101102
DEERFIELD BEACH FL
33442-1672
US

IV. Provider business mailing address

1500 NW 3RD ST STE 101102
DEERFIELD BEACH FL
33442-1672
US

V. Phone/Fax

Practice location:
  • Phone: 561-221-8397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA KARINA RUBIO
Title or Position: CEO
Credential:
Phone: 561-221-8937