Healthcare Provider Details

I. General information

NPI: 1174318018
Provider Name (Legal Business Name): DR HOMETOWN FTL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 NE 23RD TER
LIGHTHOUSE POINT FL
33064-8013
US

IV. Provider business mailing address

2436 N FEDERAL HWY # 1582436N
LIGHTHOUSE POINT FL
33064-6854
US

V. Phone/Fax

Practice location:
  • Phone: 954-860-7997
  • Fax:
Mailing address:
  • Phone: 954-860-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN M TAUBE
Title or Position: OWNER
Credential:
Phone: 954-860-7997