MEDICARE: RANDOM MS INC

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

General Provider Information

NPI Number	:	1205929049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDOM MS INC

Provider Business Mailing Address
First Line	:	4011 BROADWAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4139
Country	:	US
Telephone Number	:	561-433-1066
Fax Number	:	561-439-2566

Provider Business Practice Location Address
First Line	:	4011 BROADWAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4139
Country	:	US
Telephone Number	:	561-433-1066
Fax Number	:	561-439-2566

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE R PEREZ
Credential	:
Telephone Number	:	561-433-1066

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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Directions to “RANDOM MS INC ” Practice Location

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