Healthcare Provider Details

I. General information

NPI: 1134740061
Provider Name (Legal Business Name): HORIZON FAMILY MEDICAL PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 ROYAL PALM BEACH BLVD STE 108
ROYAL PALM BEACH FL
33411-1602
US

IV. Provider business mailing address

1236 ROYAL PALM BEACH BLVD STE 108
ROYAL PALM BEACH FL
33411-1602
US

V. Phone/Fax

Practice location:
  • Phone: 561-774-8660
  • Fax: 561-774-8665
Mailing address:
  • Phone: 561-774-8660
  • Fax: 561-774-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VALEREY BARTHELEMY
Title or Position: CREDENTIAL MANAGER
Credential:
Phone: 561-774-8660