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General NPI Number Information
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NPI Number | 1063893584
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Entity Type | Organization
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Legal Business Name | FLORIDA VIP MEDICAL LLC
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 5341 W ATLANTIC AVE SUITE 300
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8167
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Country | US
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Telephone | 561-272-5282
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Fax |
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Provider Business Mailing Address
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Address Line | 5341 W ATLANTIC AVE SUITE 300
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8167
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Country | US
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Telephone | 561-272-5282
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Fax |
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Authorized Official
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Title or Position | MD
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Name | OLGA DECKER
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Credential | M.D
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Telephone | 561-272-5282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME99104
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License Number State | FL
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