Healthcare Provider Details

I. General information

NPI: 1992740674
Provider Name (Legal Business Name): 2047 PALM BEACH LAKES PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6500
US

IV. Provider business mailing address

2047 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6500
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-1330
  • Fax: 561-296-3469
Mailing address:
  • Phone: 561-296-1330
  • Fax: 561-296-3469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number924
License Number StateFL

VIII. Authorized Official

Name: DR. JONATHAN CUTLER
Title or Position: MANAGING PARTNER
Credential:
Phone: 561-796-1330