=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760614754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOYNTON MANAGEMENT CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2009
-----------------------------------------------------
Last Update Date | 08/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3795 W BOYNTON BEACH BLVD SUITE A
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-736-2001
-----------------------------------------------------
Fax | 561-740-0771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3795 W BOYNTON BEACH BLVD SUITE A
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-736-2001
-----------------------------------------------------
Fax | 561-740-0771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARK B FREEMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-736-2001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------