Healthcare Provider Details

I. General information

NPI: 1558797506
Provider Name (Legal Business Name): DOCTORS HOUSE CALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SE 2ND AVE
DELRAY BEACH FL
33444-3615
US

IV. Provider business mailing address

55 SE 2ND AVE
DELRAY BEACH FL
33444-3615
US

V. Phone/Fax

Practice location:
  • Phone: 561-613-7359
  • Fax: 561-613-7359
Mailing address:
  • Phone: 561-613-7359
  • Fax: 561-613-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MALON S DEVINE
Title or Position: CEO
Credential: ARNP
Phone: 561-613-7359