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General NPI Number Information
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NPI Number | 1629251277
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Entity Type | Organization
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Legal Business Name | JUPITER MEDICAL CENTER PHYSICIAN GROUP
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 399 TEQUESTA DR SUITE 102
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City | TEQUESTA
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State | FL
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Zip | 33469-3087
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Country | US
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Telephone | 561-748-2889
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Fax | 561-748-1523
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Provider Business Mailing Address
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Address Line | PO BOX 8850
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City | JUPITER
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State | FL
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Zip | 33468-8850
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Country | US
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Telephone | 561-748-2889
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Fax | 561-748-1523
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Authorized Official
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Title or Position | OWNER BILLING COMPANY
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Name | KAREN BARLOW
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Credential |
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Telephone | 561-748-2889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0044113
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License Number State | FL
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