Healthcare Provider Details

I. General information

NPI: 1023063591
Provider Name (Legal Business Name): JEREMY MICHAEL SEGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRAIL MEDICINE (111)
WEST PALM BEACH FL
33410
US

IV. Provider business mailing address

7305 N MILITARY TRAIL MEDICINE (111)
WEST PALM BEACH FL
33410
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-6650
  • Fax: 561-422-8708
Mailing address:
  • Phone: 561-422-6650
  • Fax: 561-422-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME80418
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME80418
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME80418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: