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General NPI Number Information
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NPI Number | 1942641667
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Entity Type | Organization
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Legal Business Name | PALM BEACH MEDICINE LLC
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 3319 STATE ROAD 7 SUITE 207
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City | WELLINGTON
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State | FL
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Zip | 33449-8094
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Country | US
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Telephone | 561-753-1101
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Fax | 561-753-1105
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Provider Business Mailing Address
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Address Line | 11101 S CROWN WAY SUITE 1
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City | WELLINGTON
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State | FL
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Zip | 33414-8792
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Country | US
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Telephone | 561-795-9150
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Fax | 561-798-7700
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Authorized Official
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Title or Position | OWNER
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Name | DAMARIS PEREZ
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Credential |
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Telephone | 561-753-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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