MEDICARE: NEIGHBORHOOD FAMILY DOCTOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME63826	FL

General Provider Information

NPI Number	:	1093915316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD FAMILY DOCTOR

Provider Business Mailing Address
First Line	:	4949 S CONGRESS AVE
Second Line	:	STE B
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4731
Country	:	US
Telephone Number	:	561-969-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 S CONGRESS AVE
Second Line	:	STE B
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4731
Country	:	US
Telephone Number	:	561-969-1777
Fax Number	:

Authorized Official
Title or Position	:	ADMININSTRATIVE
Name	:	MR. ITA CAMPOS
Credential	:
Telephone Number	:	561-969-1777

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	03/27/2008

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Directions to “NEIGHBORHOOD FAMILY DOCTOR ” Practice Location

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