Healthcare Provider Details

I. General information

NPI: 1720607484
Provider Name (Legal Business Name): BLACK STALLION WALK-IN AND EXERCISE MEDICINE CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9955 SE FEDERAL HWY
HOBE SOUND FL
33455-4829
US

IV. Provider business mailing address

9955 SE FEDERAL HWY
HOBE SOUND FL
33455-4829
US

V. Phone/Fax

Practice location:
  • Phone: 772-932-9310
  • Fax:
Mailing address:
  • Phone: 772-932-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACIA PIERRE-PIERRE
Title or Position: OWNER
Credential: MD
Phone: 772-932-9310