Healthcare Provider Details
I. General information
NPI: 1518360726
Provider Name (Legal Business Name): FAMILY HEALTH CARE OF DELRAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7100 S MILITARY TRL SUITE 7126
LAKE WORTH FL
33463-7812
US
IV. Provider business mailing address
7100 S MILITARY TRL SUITE 7126
LAKE WORTH FL
33463-7812
US
V. Phone/Fax
- Phone: 561-822-3167
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RA0401X |
| Taxonomy | Addiction Medicine (Internal Medicine) Physician |
| License Number | ME69471 |
| License Number State | FL |
VIII. Authorized Official
Name: DR.
SERGE
ALEXANDRE
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 561-613-5450