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General NPI Number Information
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NPI Number | 1134421589
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Entity Type | Organization
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Legal Business Name | EDGAR IBANEZ MD, PA
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 2609 W WOOLBRIGHT RD STE 4C
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-6634
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Country | US
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Telephone | 561-738-1770
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Fax | 561-738-9992
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Provider Business Mailing Address
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Address Line | 2609 W WOOLBRIGHT RD STE 4C
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-6634
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Country | US
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Telephone | 561-738-1770
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Fax | 561-738-9992
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDGAR IBANEZ
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Credential | MD
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Telephone | 561-738-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME35446
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License Number State | FL
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