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General NPI Number Information
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NPI Number | 1033507330
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Entity Type | Organization
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Legal Business Name | JPLRC
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 108 INTRACOASTAL POINTE DR
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City | JUPITER
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State | FL
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Zip | 33477-5036
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Country | US
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Telephone | 561-529-4494
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Fax |
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Provider Business Mailing Address
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Address Line | 108 INTRACOASTAL POINTE DR STE 300
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City | JUPITER
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State | FL
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Zip | 33477-5036
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Country | US
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Telephone | 561-529-4494
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Fax | 561-529-4494
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Authorized Official
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Title or Position | MEDICAL DIRECTOR, SOLE PROPRIETOR
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Name | DR. MATTHEW HARRIS
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Credential | MD
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Telephone | 347-891-1546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | ME111506
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME111506
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License Number State | FL
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