MEDICARE: DR. NATHAN EDWARD NACHLAS MD

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	207YS0123X	Facial Plastic Surgery Physician	ME 49831	FL

General Provider Information

NPI Number	:	1497737647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN EDWARD NACHLAS MD

Provider Business Mailing Address
First Line	:	1601 CLINT MOORE RD STE 170
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-2768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CLINT MOORE RD STE 170
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-2768
Country	:	US
Telephone Number	:	561-939-0900
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/13/2008

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