Healthcare Provider Details

I. General information

NPI: 1720484686
Provider Name (Legal Business Name): PALM BEACH FACIAL PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 PROFESSIONAL CENTER DR STE 310
PALM BEACH GARDENS FL
33410-4280
US

IV. Provider business mailing address

4280 PROFESSIONAL CENTER DR STE 310
PALM BEACH GARDENS FL
33410-4280
US

V. Phone/Fax

Practice location:
  • Phone: 561-659-9766
  • Fax:
Mailing address:
  • Phone: 561-659-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME91139
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME91139
License Number StateFL

VIII. Authorized Official

Name: DR. MARK R MURPHY
Title or Position: OWNER
Credential: MD
Phone: 561-659-9766