Healthcare Provider Details

I. General information

NPI: 1497958110
Provider Name (Legal Business Name): KAPNICK & GOODMAN MDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 LEEWARD DR
JUPITER FL
33477-9338
US

IV. Provider business mailing address

335 LEEWARD DR
JUPITER FL
33477-9338
US

V. Phone/Fax

Practice location:
  • Phone: 561-622-3810
  • Fax: 561-775-9617
Mailing address:
  • Phone: 561-622-3810
  • Fax: 561-775-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL JASON KAPNICK
Title or Position: OWNER
Credential: MD
Phone: 561-622-3810