MEDICARE: JP FAMILY PRACTICE CENTER PA

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	207P00000X	Emergency Medicine Physician	ME0061125	FL
2	208000000X	Pediatrics Physician	ME0061125	FL
3	207Q00000X	Family Medicine Physician	ME0061125	FL

General Provider Information

NPI Number	:	1740494491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JP FAMILY PRACTICE CENTER PA

Provider Business Mailing Address
First Line	:	2401 QUANTUM BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8612
Country	:	US
Telephone Number	:	561-740-7514
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 QUANTUM BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8612
Country	:	US
Telephone Number	:	561-740-7514
Fax Number	:	561-740-1453

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JEAN SALOMON PIERRE
Credential	:	MD
Telephone Number	:	561-740-7514

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/04/2022

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