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General NPI Number Information
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NPI Number | 1306816178
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Entity Type | Individual
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Provider Name | JULIE C SERVOSS MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 3848 FAU BLVD STE 305
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City | BOCA RATON
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State | FL
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Zip | 33431-6437
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Country | US
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Telephone | 561-455-3627
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Fax | 561-393-7312
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Provider Business Mailing Address
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Address Line | 1500 NW 12TH AVE JMT-EAST 1007
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City | MIAMI
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State | FL
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Zip | 33136-1051
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Country | US
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Telephone | 305-243-4664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME94610
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License Number State | FL
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