MEDICARE: PHYSICIANS GROUP OF THE PALM BEACHES LLC

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	207RI0011X	Interventional Cardiology Physician	ME82672	FL
2	207R00000X	Internal Medicine Physician	ME80428	FL

General Provider Information

NPI Number	:	1134382641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS GROUP OF THE PALM BEACHES LLC

Provider Business Mailing Address
First Line	:	8190 JOG RD
Second Line	:	SUITE 100
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2912
Country	:	US
Telephone Number	:	561-369-2144
Fax Number	:

Provider Business Practice Location Address
First Line	:	8190 JOG RD
Second Line	:	SUITE 100
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2912
Country	:	US
Telephone Number	:	561-369-2144
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GERARDO QUINONEZ
Credential	:	MD
Telephone Number	:	561-369-2144

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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