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General NPI Number Information
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NPI Number | 1477865673
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Entity Type | Organization
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Legal Business Name | MQM MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 115 SE 4TH ST
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-4905
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Country | US
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Telephone | 561-732-2701
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Fax | 561-732-0354
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Provider Business Mailing Address
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Address Line | 115 SE 4TH ST
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-4905
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Country | US
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Telephone | 561-732-2701
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Fax | 561-732-0354
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JORGE L MACIA
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Credential | MD
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Telephone | 561-732-2701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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