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General NPI Number Information
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NPI Number | 1952538167
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Entity Type | Organization
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Legal Business Name | PRIME MD LLC
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 10115 W FOREST HILL BLVD SUITE 102
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City | WELLINGTON
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State | FL
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Zip | 33414-3105
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Country | US
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Telephone | 561-588-3385
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 S CONGRESS AVE SUITE B
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City | PALM SPRINGS
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State | FL
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Zip | 33461-2175
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Country | US
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Telephone | 561-588-3385
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER-SHAREHOLDER
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Name | DR. MANUEL ANTONIO PAREDES
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Credential | M.D.
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Telephone | 561-588-3385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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