Healthcare Provider Details

I. General information

NPI: 1629296587
Provider Name (Legal Business Name): DRIFTWOOD FAMILY PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2163 SOUTH US HWY #1
JUPITER FL
33477-7338
US

IV. Provider business mailing address

2163 SOUTH US HWY #1
JUPITER FL
33477-7338
US

V. Phone/Fax

Practice location:
  • Phone: 561-746-0208
  • Fax: 561-575-1267
Mailing address:
  • Phone: 561-746-0208
  • Fax: 561-575-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD ALAN GOLDBERG
Title or Position: PRESIDENT
Credential: DO
Phone: 561-746-0208