Healthcare Provider Details

I. General information

NPI: 1871781930
Provider Name (Legal Business Name): COUNTRY DOCTOR MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2007
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 MARLIN CIR
JUPITER FL
33458-4306
US

IV. Provider business mailing address

932 MARLIN CIR
JUPITER FL
33458-4306
US

V. Phone/Fax

Practice location:
  • Phone: 561-401-8213
  • Fax: 866-896-2367
Mailing address:
  • Phone: 561-401-8213
  • Fax: 866-896-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME59301
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME59301
License Number StateFL

VIII. Authorized Official

Name: DR. HAMILTON CARL PLATT III
Title or Position: OWNER
Credential: M.D.
Phone: 561-401-8213