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NPI Code Detail

MEDICARE: PALM BEACH MEDICAL WEIGHT LOSS LLC

MEDICARE: PALM BEACH MEDICAL WEIGHT LOSS 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
1207Q00000XFamily Medicine PhysicianFL

General Provider Information

NPI Number : 1689061202
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALM BEACH MEDICAL WEIGHT LOSS LLC
Provider Business Mailing Address
First Line : 101 SE 27TH AVE
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-7632
Country : US
Telephone Number : 561-737-8844
Fax Number : 561-738-5592
Provider Business Practice Location Address
First Line : 101 SE 27TH AVE
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-7632
Country : US
Telephone Number : 561-737-8844
Fax Number : 561-738-5592
Authorized Official
Title or Position : OWNER
Name : DAVID LASHWAY
Credential : M.D.
Telephone Number : 561-737-8844
Provider Enumeration Date : 04/21/2015
Last Update Date : 04/21/2015

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Directions to “PALM BEACH MEDICAL WEIGHT LOSS LLC ” Practice Location

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