=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013980721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURENCE EHRLICH MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2006
-----------------------------------------------------
Last Update Date | 08/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10151 ENTERPRISE CENTER BLVD SUITE 205
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-3759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-732-8102
-----------------------------------------------------
Fax | 561-732-8401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10151 ENTERPRISE CENTER BLVD SUITE 205
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-3759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-732-8102
-----------------------------------------------------
Fax | 561-732-8401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LAURENCE EHRLICH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-732-8102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0069830
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------