Healthcare Provider Details

I. General information

NPI: 1629202775
Provider Name (Legal Business Name): PREMIER MEDICAL CARE OF THE PALM BEACHES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 MILITARY TRL SUITE 102
JUPITER FL
33458-5009
US

IV. Provider business mailing address

PO BOX 1937
JUPITER FL
33468-1937
US

V. Phone/Fax

Practice location:
  • Phone: 561-745-0072
  • Fax: 561-745-0074
Mailing address:
  • Phone: 561-748-2889
  • Fax: 561-748-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS6580
License Number StateFL

VIII. Authorized Official

Name: KAREN BARLOW
Title or Position: PRESIDENT JUPITER PROFESSIONAL DEV
Credential:
Phone: 561-748-2889