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General NPI Number Information
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NPI Number | 1720607484
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Entity Type | Organization
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Legal Business Name | BLACK STALLION WALK-IN AND EXERCISE MEDICINE CLINICS LLC
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 9955 SE FEDERAL HWY
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City | HOBE SOUND
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State | FL
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Zip | 33455-4829
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Country | US
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Telephone | 772-932-9310
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Fax |
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Provider Business Mailing Address
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Address Line | 9955 SE FEDERAL HWY
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City | HOBE SOUND
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State | FL
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Zip | 33455-4829
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Country | US
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Telephone | 772-932-9310
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRACIA PIERRE-PIERRE
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Credential | MD
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Telephone | 772-932-9310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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