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General NPI Number Information
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NPI Number | 1477709244
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Entity Type | Organization
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Legal Business Name | BOCA RATON REGIONAL HOSPITAL
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 690 MEADOWS ROAD
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City | BOCA RATON
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State | FL
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Zip | 33486-2344
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Country | US
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Telephone | 561-955-3772
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Fax | 561-955-4444
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Provider Business Mailing Address
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Address Line | P.O. BOX 105046 MAIL CODE 5598
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City | ATLANTA
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State | GA
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Zip | 30348-5046
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Country | US
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Telephone | 561-955-4797
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Fax | 561-955-4723
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Authorized Official
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Title or Position | CEO
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Name | JERRY J FEDELE
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Credential |
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Telephone | 561-955-5484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME54973
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License Number State | FL
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