MEDICARE: PBD&P INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207N00000X	Dermatology Physician
2	207ND0101X	MOHS-Micrographic Surgery Physician
3	207ND0900X	Dermatopathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21482	OTHER	FL	BLUE CROSS GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689640328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PBD&P INC

Provider Business Mailing Address
First Line	:	4475 MEDICAL CENTER WAY
Second Line	:	SUITE 1
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3240
Country	:	US
Telephone Number	:	561-840-0995
Fax Number	:	561-840-0661

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	:	561-840-0995
Fax Number	:	561-840-0661

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL O SOKOLOFF
Credential	:	M.D.
Telephone Number	:	561-840-0995

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	05/04/2012

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Directions to “PBD&P INC ” Practice Location

Language	Start Address	Practice Location

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