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General NPI Number Information
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NPI Number | 1376224956
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Entity Type | Organization
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Legal Business Name | BROADER MRI OF PALM BEACH LLC
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 5405 OKEECHOBEE BLVD #100
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City | WEST PALM BEACH
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State | FL
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Zip | 33417
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Country | US
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Telephone | 561-766-0304
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Fax | 305-768-9164
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Provider Business Mailing Address
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Address Line | 5405 OKEECHOBEE BLVD #100
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City | WEST PALM BEACH
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State | FL
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Zip | 33417
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Country | US
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Telephone | 561-766-0304
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Fax | 305-768-9164
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Authorized Official
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Title or Position | OWNER
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Name | MANUEL IRIBAR
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Credential | MD
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Telephone | 561-766-0304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 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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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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