Healthcare Provider Details

I. General information

NPI: 1396517355
Provider Name (Legal Business Name): PALM BEACH JOINT REPLACEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 INTRACOASTAL POINTE DR STE 200
JUPITER FL
33477-5036
US

IV. Provider business mailing address

108 INTRACOASTAL POINTE DR STE 200
JUPITER FL
33477-5036
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-7124
  • Fax: 561-330-6606
Mailing address:
  • Phone: 561-900-7124
  • Fax: 561-330-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT FOWBLE
Title or Position: OWNER
Credential: MD
Phone: 561-310-4563