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NPI Code Detail

MEDICARE: IRIS KO PA-C

MEDICARE: IRIS KO PA-C
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
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1730916958
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRIS KO PA-C
Provider Business Mailing Address
First Line : 5818 S DIXIE HWY
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33405-3608
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5818 S DIXIE HWY
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33405-3608
Country : US
Telephone Number : 561-782-5967
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2024
Last Update Date : 09/19/2024

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Directions to “ IRIS KO PA-C” Practice Location

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