Healthcare Provider Details

I. General information

NPI: 1558203034
Provider Name (Legal Business Name): DR. HOMETOWN JUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NE 23RD AVE STE 3
POMPANO BEACH FL
33062-5247
US

IV. Provider business mailing address

1 NE 23RD AVE STE 3
POMPANO BEACH FL
33062-5247
US

V. Phone/Fax

Practice location:
  • Phone: 954-280-8228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN JOEL
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 954-280-1688