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General NPI Number Information
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NPI Number | 1558788182
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Entity Type | Organization
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Legal Business Name | ADVANCED DIAGNOSTIC LABORATORY SERVICES
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 3100 NW BOCA RATON BLVD STE 114
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City | BOCA RATON
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State | FL
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Zip | 33431-6651
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Country | US
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Telephone | 561-366-2327
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 NW BOCA RATON BLVD STE 114
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City | BOCA RATON
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State | FL
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Zip | 33431-6651
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Country | US
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Telephone | 561-366-2327
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Fax |
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. PETER BOYD
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Credential | M.D.
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Telephone | 239-860-0766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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