MEDICARE: PATRIC R MCPOLAND 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	207N00000X	Dermatology Physician	ME49528	FL

General Provider Information

NPI Number	:	1588638159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRIC R MCPOLAND MD

Provider Business Mailing Address
First Line	:	4475 MEDICAL CENTER WAY
Second Line	:	SUITE 2
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3240
Country	:	US
Telephone Number	:	561-863-1000
Fax Number	:	561-863-1319

Provider Business Practice Location Address
First Line	:	4475 MEDICAL CENTER WAY
Second Line	:	SUITE 2
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3240
Country	:	US
Telephone Number	:	561-863-1000
Fax Number	:	561-863-1319

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	08/17/2011

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