Healthcare Provider Details

I. General information

NPI: 1689614901
Provider Name (Legal Business Name): JAIRO RESTREPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 FOREST HILL BLVD SUITE 103
WEST PALM BEACH FL
33406-6063
US

IV. Provider business mailing address

3255 FOREST HILL BLVD STE 103
PALM SPRINGS FL
33406-5854
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-4577
  • Fax: 561-964-7772
Mailing address:
  • Phone: 561-964-4577
  • Fax: 561-275-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME81527
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME81527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: