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General NPI Number Information
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NPI Number | 1265567994
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Entity Type | Organization
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Legal Business Name | COLUMBIA PRIMARY CARE LLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 4631 N CONGRESS AVE SUITE 202
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-3209
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Country | US
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Telephone | 561-881-2640
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Fax | 561-863-2304
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Provider Business Mailing Address
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Address Line | 4631 N CONGRESS AVE SUITE 202
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-3209
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Country | US
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Telephone | 561-881-2640
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Fax | 561-863-2304
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Authorized Official
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Title or Position | VP
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Name | GARY DUNCAN
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Credential |
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Telephone | 561-881-2640
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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 |
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License Number State |
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