MEDICARE: CONCIERGE MEDICINE OF JUPITER 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	ME72879	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42634A	OTHER	FL	MEDICARE ID

General Provider Information

NPI Number	:	1912281130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCIERGE MEDICINE OF JUPITER INC.

Provider Business Mailing Address
First Line	:	2151 SOUTH ALT A1A SUITE 950
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33477-4064
Country	:	US
Telephone Number	:	561-743-2239
Fax Number	:	561-768-9700

Provider Business Practice Location Address
First Line	:	2151 SOUTH ALT A1A SUITE 950
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33477-4064
Country	:	US
Telephone Number	:	561-743-2239
Fax Number	:	561-768-9700

Authorized Official
Title or Position	:	OWNER
Name	:	CATHERINE G DROURR
Credential	:	MD
Telephone Number	:	561-743-2239

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	08/09/2021

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