MEDICARE: WEST PALM BEACH FAMILY DOCTORS, 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	207Q00000X	Family Medicine Physician		FL

General Provider Information

NPI Number	:	1821071366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PALM BEACH FAMILY DOCTORS, INC

Provider Business Mailing Address
First Line	:	2500 METROCENTRE BLVD
Second Line	:	SUITE 1
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3107
Country	:	US
Telephone Number	:	561-434-5678
Fax Number	:	561-964-9829

Provider Business Practice Location Address
First Line	:	2500 METROCENTRE BLVD
Second Line	:	SUITE 7
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3107
Country	:	US
Telephone Number	:	561-434-5678
Fax Number	:	561-964-9829

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANA P RICHARD
Credential	:	DO
Telephone Number	:	561-434-5678

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	05/15/2015

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