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General NPI Number Information
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NPI Number | 1043625718
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Entity Type | Organization
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Legal Business Name | WPB MEDICAL PROVIDER, INC.
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Dates
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Enumeration Date | 06/21/2014
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Last Update Date | 06/21/2014
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Provider Practice Location Address
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Address Line | 464 FERN ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5818
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Country | US
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Telephone | 561-822-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 464 FERN ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5818
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Country | US
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Telephone | 561-822-2000
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. COLLEEN PARKHURST
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Credential |
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Telephone | 561-822-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3201662
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License Number State | FL
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