Healthcare Provider Details

I. General information

NPI: 1700276201
Provider Name (Legal Business Name): PHYSICIANS GROUP OF THE PALM BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OLD DIXIE HWY
TEQUESTA FL
33469-2493
US

IV. Provider business mailing address

701 OLD DIXIE HWY
TEQUESTA FL
33469-2493
US

V. Phone/Fax

Practice location:
  • Phone: 561-935-5795
  • Fax:
Mailing address:
  • Phone: 561-935-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: VALERIE JACKSON
Title or Position: CEO
Credential:
Phone: 561-935-4227