Healthcare Provider Details

I. General information

NPI: 1942641667
Provider Name (Legal Business Name): PALM BEACH MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 STATE ROAD 7 SUITE 207
WELLINGTON FL
33449-8094
US

IV. Provider business mailing address

11101 S CROWN WAY SUITE 1
WELLINGTON FL
33414-8792
US

V. Phone/Fax

Practice location:
  • Phone: 561-753-1101
  • Fax: 561-753-1105
Mailing address:
  • Phone: 561-795-9150
  • Fax: 561-798-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAMARIS PEREZ
Title or Position: OWNER
Credential:
Phone: 561-753-1101