Healthcare Provider Details

I. General information

NPI: 1124357363
Provider Name (Legal Business Name): JOHN G WESTINE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DIXIE BLVD SUITE 103
DELRAY BEACH FL
33444-3857
US

IV. Provider business mailing address

250 DIXIE BLVD SUITE 103
DELRAY BEACH FL
33444-3857
US

V. Phone/Fax

Practice location:
  • Phone: 561-278-3245
  • Fax: 561-276-1904
Mailing address:
  • Phone: 561-278-3245
  • Fax: 561-276-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number81964
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN GANSON WESTINE
Title or Position: OWNER
Credential: MD
Phone: 561-278-3245