=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962748020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DELORES ARNOLD M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2012
-----------------------------------------------------
Last Update Date | 12/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11750 WATERCREST LANE
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-488-4431
-----------------------------------------------------
Fax | 561-488-4431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11750 WATERCREST LANE
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-488-4431
-----------------------------------------------------
Fax | 561-488-4431
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME27239
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------