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General NPI Number Information
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NPI Number | 1710183744
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Entity Type | Organization
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Legal Business Name | PALM BEACH MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 9123 N MILITARY TRL SUITE 102
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City | WEST PALM BEACH
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State | FL
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Zip | 33410-5990
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Country | US
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Telephone | 561-630-9339
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Fax |
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Provider Business Mailing Address
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Address Line | 13833 WELLINGTON TRCE E4-#204
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City | WELLINGTON
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State | FL
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Zip | 33414-2116
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Country | US
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Telephone | 561-584-4142
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER OWNER
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Name | DR. STEPHEN KWASHIE WOYOME
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Credential | M.D.,
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Telephone | 561-584-4142
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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 | ME9587
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License Number State | FL
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