Healthcare Provider Details

I. General information

NPI: 1043618762
Provider Name (Legal Business Name): SOUTH FLORIDA MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 UNIVERSITY BLVD
JUPITER FL
33458-3103
US

IV. Provider business mailing address

3343 STATE ROAD 7
WELLINGTON FL
33449-8002
US

V. Phone/Fax

Practice location:
  • Phone: 561-748-2488
  • Fax: 561-748-2468
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: RAJIV PATEL
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 561-795-9845