MEDICARE: HAN MING DU A.P. DOM

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	261Q00000X	Clinic/Center	AP968	FL

General Provider Information

NPI Number	:	1104282854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAN MING DU A.P. DOM

Provider Business Mailing Address
First Line	:	15300 JOG RD STE 209
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2166
Country	:	US
Telephone Number	:	561-381-3303
Fax Number	:	561-381-3303

Provider Business Practice Location Address
First Line	:	15300 JOG RD STE 209
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2166
Country	:	US
Telephone Number	:	561-381-3303
Fax Number	:	561-381-3303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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