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General NPI Number Information
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NPI Number | 1255529186
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Entity Type | Organization
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Legal Business Name | WEST BOCA PHYSICIANS GROUP INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 21644 STATE ROAD 7
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City | BOCA RATON
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State | FL
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Zip | 33428-1842
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Country | US
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Telephone | 561-883-7029
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 NW 14TH ST SUITE 190
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City | SUNRISE
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State | FL
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Zip | 33323-2865
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Country | US
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Telephone | 800-424-3672
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN G. HOLTZCLAW
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Credential | M.D.
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Telephone | 800-424-3672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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