MEDICARE: GARDENS MEDICAL OFFICE, 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	207R00000X	Internal Medicine Physician	ME98041	FL

General Provider Information

NPI Number	:	1710284955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDENS MEDICAL OFFICE, INC.

Provider Business Mailing Address
First Line	:	7100 FAIRWAY DR
Second Line	:	SUITE #32
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3777
Country	:	US
Telephone Number	:	561-626-0567
Fax Number	:	561-626-0557

Provider Business Practice Location Address
First Line	:	7100 FAIRWAY DR
Second Line	:	SUITE #32
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3777
Country	:	US
Telephone Number	:	561-626-0567
Fax Number	:	561-626-0557

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BEAU RICHARD BOSHERS
Credential	:	M.D.
Telephone Number	:	561-626-0567

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	02/24/2011

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