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General NPI Number Information
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NPI Number | 1114140092
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Entity Type | Organization
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Legal Business Name | PHYSICIANS PARK MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 124 SW 1ST ST
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City | BELLE GLADE
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State | FL
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Zip | 33430-3472
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Country | US
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Telephone | 561-992-2316
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Fax | 561-993-3860
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Provider Business Mailing Address
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Address Line | 12333 EQUINE LN
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City | WELLINGTON
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State | FL
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Zip | 33414-3503
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Country | US
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Telephone | 561-992-2316
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Fax | 561-993-3860
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YAW O ABU
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Credential |
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Telephone | 561-992-2316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME73613
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME71517
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License Number State | FL
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