Healthcare Provider Details

I. General information

NPI: 1699507756
Provider Name (Legal Business Name): GREEN TREE FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 9300B
WEST PALM BEACH FL
33401-3404
US

IV. Provider business mailing address

1411 N FLAGLER DR STE 9300B
WEST PALM BEACH FL
33401-3404
US

V. Phone/Fax

Practice location:
  • Phone: 561-941-3399
  • Fax: 561-941-3398
Mailing address:
  • Phone: 561-941-3399
  • Fax: 561-941-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEGAN E GABBIDON
Title or Position: PHYSICIAN
Credential: DO
Phone: 561-941-3399